Provider Demographics
NPI:1528469707
Name:PROSPECT CHARTERCARE RWMC, LLC
Entity type:Organization
Organization Name:PROSPECT CHARTERCARE RWMC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRATITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-456-2000
Mailing Address - Street 1:84 COLVINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-8516
Mailing Address - Country:US
Mailing Address - Phone:401-480-7002
Mailing Address - Fax:401-861-9596
Practice Address - Street 1:84 COLVINTOWN RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-8516
Practice Address - Country:US
Practice Address - Phone:401-480-7002
Practice Address - Fax:401-861-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital