Basic Information
| Provider Information | |||||||||
| NPI: | 1750631990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHEILA SMITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028951771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017621511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1625 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028951771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017621511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4017802300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | RR0217910 | RI | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.