Basic Information
| Provider Information | |||||||||
| NPI: | 1720014442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEETING STREET CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 EDDY STREET | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015339100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 EDDY STREET | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015339100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 02/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | MALONE | ||||||||
| AuthorizedOfficialFirstName: | LYNNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4015339100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QM3000X | N | Ambulatory Health Care Facilities | Clinic/Center | Medically Fragile Intants and Children Day Care | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
ID Information
| ID | Type | State | Issuer | Description | 2092 | 01 | RI | EI NHPRC NUMBER | OTHER | 9009994 | 05 | RI | MEDICAID | ES01788 | 05 | RI | MEDICAID | 4600103 | 01 | RI | SL UHP NUMBER | OTHER | 6400144 | 01 | RI | PT/OT UHP NUMBER | OTHER | MS59102 | 05 | RI | MEDICAID | 292177 | 01 | RI | EI BLUE CROSS NUMBER | OTHER | 2058 | 01 | RI | SS NHPRC NUMBER | OTHER | 412296 | 01 | RI | EI BCHIP NUMBER | OTHER | 99947 | 01 | RI | SS BLUE CROSS | OTHER |