Healthcare Provider Details

I. General information

NPI: 1558658963
Provider Name (Legal Business Name): COVENTRY SKILLED NURSING AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND DRIVE
COVENTRY RI
02816
US

IV. Provider business mailing address

10 WOODLAND DRIVE
COVENTRY RI
02816
US

V. Phone/Fax

Practice location:
  • Phone: 401-826-2000
  • Fax:
Mailing address:
  • Phone: 401-826-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA00568
License Number StateRI

VIII. Authorized Official

Name: MISS KERRI KATHLEEN LEWIS
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PTA
Phone: 401-826-2000