State of Rhode Island and Providence Plantations
NPI 1104961242 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Pascoag, RI
State of Rhode Island and Providence Plantations is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility organization in Pascoag, RI (NPI 1104961242).
Provider details
- NPI number
- 1104961242
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Jennifer White, Deputy Cfo(401) 462-1343
- License
- 48 (RI)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 48 (RI)
Residential Treatment Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- East Wallum Lake Group Home
Registry dates
- Enumerated
- 2007-02-20
- Last updated
- 2019-08-22
Frequently asked questions
- What is State of Rhode Island and Providence Plantations's NPI number?
- State of Rhode Island and Providence Plantations's National Provider Identifier (NPI) is 1104961242, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is State of Rhode Island and Providence Plantations?
- State of Rhode Island and Providence Plantations is classified in the NPPES registry as Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (Residential Treatment Facilities).
- Where is State of Rhode Island and Providence Plantations located?
- State of Rhode Island and Providence Plantations's practice location on file with NPPES is 1710 East Wallum Lake Road, Pascoag, RI 02859-1825.
- What is State of Rhode Island and Providence Plantations's phone number?
- The practice phone number listed in the NPPES registry for State of Rhode Island and Providence Plantations is (401) 567-0990.
- Who is the authorized official for State of Rhode Island and Providence Plantations?
- The authorized official listed on State of Rhode Island and Providence Plantations's NPPES record is Jennifer White, Deputy Cfo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is State of Rhode Island and Providence Plantations's NPI active?
- Yes — State of Rhode Island and Providence Plantations's NPI (1104961242) is active in the NPPES registry as of the last update on 2019-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.