Healthcare Provider Details

I. General information

NPI: 1093966608
Provider Name (Legal Business Name): 735 PUTNAM PIKE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PUTNAM PIKE
GREENVILLE RI
02828-1435
US

IV. Provider business mailing address

735 PUTNAM PIKE
GREENVILLE RI
02828-1435
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-1200
  • Fax: 401-949-0968
Mailing address:
  • Phone: 401-949-1200
  • Fax: 401-949-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC00734
License Number StateRI

VIII. Authorized Official

Name: MICHAEL T BERG
Title or Position: SECRETARY
Credential:
Phone: 505-468-4742