Healthcare Provider Details

I. General information

NPI: 1316064140
Provider Name (Legal Business Name): MANSION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CLAY ST
CENTRAL FALLS RI
02863-3023
US

IV. Provider business mailing address

104 CLAY ST
CENTRAL FALLS RI
02863-3023
US

V. Phone/Fax

Practice location:
  • Phone: 401-726-5020
  • Fax: 401-728-1814
Mailing address:
  • Phone: 401-726-5020
  • Fax: 401-728-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number298
License Number StateRI

VIII. Authorized Official

Name: DR. JOHN CHOPOORIAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 401-726-5020