Healthcare Provider Details

I. General information

NPI: 1659355519
Provider Name (Legal Business Name): SAINT ELIZABETH MANOR EAST BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAWN HILL RD
BRISTOL RI
02809-3903
US

IV. Provider business mailing address

1 DAWN HILL RD
BRISTOL RI
02809-3903
US

V. Phone/Fax

Practice location:
  • Phone: 401-253-2300
  • Fax: 401-254-1919
Mailing address:
  • Phone: 401-253-2300
  • Fax: 401-254-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC00667
License Number StateRI

VIII. Authorized Official

Name: ELIZABETH RUSSELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-253-2300