NICKERSON COMMUNITY CENTER (NPI# 1457549578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457549578 |
| Entity Type | Organization |
| Organization Name | NICKERSON COMMUNITY CENTER |
| Practice Address |
97 Delaine St Providence RI 02909-2726 |
| Mailing Address |
133 Delaine St Providence RI 02909-2728 |
| Practice Telephone | 4013835672 |
| Mailing Telephone | 4013512241 |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |
| Authorized Official Name | LISA D'AMBRA (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4013512241 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
97 DELAINE ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02909-2726 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578021754 | Roberta Bellas Portugal | Registered Nurse | Behave Care, 188 Valley St, Providence, RI 02909 | 2019-03-07 |
| 1912137324 | Catherine Elaine Tuttle | Social Worker | 623 Atwells Avenue, Suite 201, Providence, RI 02909 | 2009-07-20 |
| 1477736452 | City Dental, LLC | Dentist | 314f Pocasset Avenue, Providence, RI 02909 | 2007-12-12 |
| 1245449651 | Walter R. Vandyck | Occupational Therapist | Springfield Middle School, Providene School Department, 152 Springfield St, Providence, RI 02909 | 2007-05-22 |
| 1780805283 | Marcel A Trisvan | Counselor | Codac Providence, 349 Huntington Ave, Providence, RI 02909 | 2007-05-01 |
| 1215153945 | Codac Inc | Peer Specialist | 349 Huntington Ave, Codac Providence, Providence, RI 02909 | 2007-04-18 |
| 1316076342 | Mulak Chiropractic Center Inc | Chiropractor | 411 Broadway, Providence, RI 02909 | 2007-03-05 |
| 1710042742 | Michael Antonio Pensa | Chiropractor | 45 Eagle St Bld J Unit 100, Providence, RI 02909 | 2006-12-27 |
| 1780768234 | Providence Community Action | Case Management | 662 Hartford Avenue, Providence, RI 02909 | 2006-10-24 |
| 1881629608 | Cora Brigid Mayer | Counselor | 623 Atwells Ave., Communities for People, Inc., Providence, RI 02909 | 2006-07-11 |
| Find all providers in zip 02909 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407076227 | Youth Services International Holdings | Residential Treatment Facility, Emotionally Disturbed Children | 188 Academy Ave, Providence, RI 02908-4452 | 2007-04-26 |
| 1245362185 | Washington Park Citizens Association, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1279 Broad St, Providence, RI 02905-2935 | 2007-03-09 |
| 1609818210 | The Providence Center | Residential Treatment Facility, Emotionally Disturbed Children | 90 Plain St, Providence, RI 02903-4817 | 2006-06-11 |
| 1952524142 | The Whitmarsh Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 1055 N Main St, Providence, RI 02904 | 2007-04-10 |
| 1457476954 | Groden Center, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 86 Mount Hope Ave, Providence, RI 02906-1648 | 2007-03-21 |
| 1063547776 | Family Service of Rhode Island Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 134 Thurbers Ave, Providence, RI 02905-4754 | 2007-02-22 |
| 1659442291 | Communities for People, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 623 Atwells Ave, Providence, RI 02909-7403 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760606396 | Community Solutions, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 785 Greenville Ave, Johnston House, Johnston, RI 02919-1329 | 2007-04-13 |
| 1508080136 | Community Solutions, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 344 Hopkins Hill Rd, Coventry House, Coventry, RI 02816-6332 | 2007-04-13 |
| 1235259631 | Ocean Tides | Residential Treatment Facility, Emotionally Disturbed Children | 635 Ocean Rd, Narragansett, RI 02882-1314 | 2007-03-30 |
| 1386760536 | Perspectives Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 125 Sand Turn Rd, South Kingstown, RI 02879 | 2007-03-21 |
| 1124152392 | Children's Shelter of Blackstone Valley, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 15 Gates St, Pawtucket, RI 02861-3225 | 2007-03-16 |
| 1457484875 | Lighthouse for Youth | Residential Treatment Facility, Emotionally Disturbed Children | 81 Spencer Ct, Wakefield, RI 02879-2820 | 2007-03-14 |
| 1760513600 | Oakmont Community Resources, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 35 Amey St, Pawtucket, RI 02860-1106 | 2007-03-09 |
| 1508997628 | Turning Point | Residential Treatment Facility, Emotionally Disturbed Children | 5 Kids Way, Pawtucket, RI 02860-2206 | 2007-03-08 |
| 1881735389 | Justice Resource Institute, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 818 Dyer Ave, Cranston, RI 02920-6714 | 2007-02-09 |
| 1598834673 | Eckerd Youth Alternatives Inc | Residential Treatment Facility, Emotionally Disturbed Children | One Camp E Hun Tee Place, Exeter, RI 02822-1406 | 2006-11-06 |
| Find all providers with the same taxonomy | ||||
| City | PROVIDENCE |
| Zip Code | 02909 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.