Organization · Type 2 NPI

Rhode Island Community Living and Supports (riclas)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Coventry, RI

NPI number 1124738281 Active

Practice location

45 Lakehurst Drive
Coventry, RI 02816

Call (401) 462-5332 Map

Fax (401) 462-2804

Mailing address

6 Harrington Road
Cranston, RI 02920

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary	320900000X	None listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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NPI record

NPI: 1124738281
Entity type: Organization (Type 2)
Issued: Nov 30, 2022
Last updated: Nov 30, 2022
Status: Active
Subpart: Yes of Rhode Island Community Living and Supports

Other names

45 Lakehurst Drive Group Home · doing business as

Authorized official

Richard R Charest
Director
(401) 462-0917

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1124738281

Rhode Island Community Living and Supports (riclas)'s National Provider Identifier is 1124738281, issued on Nov 30, 2022. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Coventry, RI. The record was last updated on Nov 30, 2022.