Basic Information
| Provider Information | |||||||||
| NPI: | 1467654640 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI-TOWN ECONOMIC OPPORTUNITY COUNSEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 HARTFORD AVE | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029197130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013512750 | ||||||||
| FaxNumber: | 4013516756 | ||||||||
| Practice Location | |||||||||
| Address1: | 1126 HARTFORD AVE | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029197130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013512750 | ||||||||
| FaxNumber: | 4013516756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DISANTIS | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4013512750 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | TT07673 | 05 | RI | MEDICAID |