National Provider Identifier Database

THE TAVARES PEDIATRIC CENTER INC
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

THE TAVARES PEDIATRIC CENTER INC
101 PLAIN ST
PROVIDENCE, RI02903-4824
Phone: 401-272-7127
Fax: 401-272-4752
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X
Skilled Nursing Facility 314000000X

* Indicates primary specialty

NPI Profile & details for THE TAVARES PEDIATRIC CENTER INC

NPI Number 1366442899
Legal business name
LBN
THE TAVARES PEDIATRIC CENTER INC
Authorized official EUGENE TAVARES - (ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 07/27/2005
Last updated 09/11/2025 - About 9 months ago
Sole proprietor1 Not specified
Identifiers
  • RI License #: RI 642
  • RI Medicaid: 41G085

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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