NPI 1366442899 · live from the CMS NPI Registry
The Tavares Pediatric Center INC
Intermediate Care Facility, Intellectual Disabilities in Providence, RI. National Provider Identifier 1366442899, active.
NPI record
| NPI | 1366442899 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Intermediate Care Facility, Intellectual Disabilities 315P00000X |
| Practice location | 101 Plain St, Providence, RI 02903 |
| Practice phone | 401-272-7127 |
| Enumerated | July 27, 2005 |
| Last updated | September 11, 2025 |
| Authorized official | Eugene Tavares, Administrator |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility | 314000000X | RI 642 (RI) |
| Intermediate Care Facility, Intellectual Disabilities primary | 315P00000X | RI 642 (RI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.