Healthcare Provider Details

I. General information

NPI: 1982094850
Provider Name (Legal Business Name): LIVING WELL ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WASHINGTON ST
CENTRAL FALLS RI
02863-2879
US

IV. Provider business mailing address

30 WASHINGTON ST
CENTRAL FALLS RI
02863-2879
US

V. Phone/Fax

Practice location:
  • Phone: 401-523-4397
  • Fax:
Mailing address:
  • Phone: 401-523-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC00039
License Number StateRI

VIII. Authorized Official

Name: GREGORY SCOTT ANDRADE
Title or Position: OWNER
Credential:
Phone: 401-523-4397