EAST WALLUM LAKE GROUP HOME
NPI 1104961242
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Pascoag, RI

Q: What is State Of Rhode Island And Providence Plantations's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Active since February 20, 2007

1710 EAST WALLUM LAKE ROAD, PASCOAG, RI 02859(401) 567-0990 Get Directions Write a Review

NPPES record last updated: August 22, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About East Wallum Lake Group Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAST WALLUM LAKE GROUP HOME (NPI 1104961242) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Pascoag, Rhode Island and active in the NPI registry since February 2007. The organization lists Jennifer Rae White, Deputy Cfo, as its authorized official.

NPPES Registry Identity

NPI1104961242

Entity TypeOrganization

Primary Taxonomy320900000X

Legal Business NameSTATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

Location Address1710 EAST WALLUM LAKE ROADPascoag, RI 02859-1825

Mailing Address1710 E Wallum Lake RdPascoag, RI 02859-1825 · (401) 567-0990 · Fax (401) 567-0147

Phone(401) 567-0990

Organization SubpartNo

Authorized OfficialJennifer Rae WhiteDeputy Cfo · (401) 462-1343

Enumeration DateFebruary 20, 2007

Last NPPES UpdateAugust 22, 2019

✔ NPI 1104961242 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

License✔ Licensed in RI · 48

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

1710 EAST WALLUM LAKE ROAD, Pascoag, RI 02859

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Other Names 1

Doing Business AsEast Wallum Lake Group Home

Other Identifiers 1

MedicaidEW12083RI

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of Rhode Island And Providence Plantations's NPI number?

The NPI number for State Of Rhode Island And Providence Plantations is 1104961242. It was assigned to this organization in the NPPES registry on February 20, 2007. The provider is doing business as East Wallum Lake Group Home.

Where is State Of Rhode Island And Providence Plantations located?

State Of Rhode Island And Providence Plantations is located at 1710 East Wallum Lake Road, Pascoag, RI 02859. The listed phone number is (401) 567-0990.

What is State Of Rhode Island And Providence Plantations's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for State Of Rhode Island And Providence Plantations was last updated on August 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.