TAVARES PEDIATRIC CENTER NPI 1598368235

NPI Information

TAVARES PEDIATRIC CENTER is an intermediate care facility mentally retarded in Providence, RI. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. TAVARES PEDIATRIC CENTER NPI is 1598368235. The provider is registered as an organization entity type.
The provider Is Doing Business As Tavares Pediatric Center.

The provider's business location address is:

101 PLAIN ST
PROVIDENCE, RI
ZIP 02903-828
Phone: (401) 272-7127
Fax: (401) 272-4752

The provider's authorized official is Vivian M Tavares .
The authorized official title is Fin Adm and has the following contact phone number (401) 272-7127.

The CLIA number assigned to this NPI record is 41D0681977 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2020 and was last updated on 11/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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