Healthcare Provider Details

I. General information

NPI: 1003895905
Provider Name (Legal Business Name): MEDICAL HOMES OF RHODE ISLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 OLD POCASSET RD
JOHNSTON RI
02919
US

IV. Provider business mailing address

49 OLD POCASSET RD
JOHNSTON RI
02919-3111
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-2450
  • Fax:
Mailing address:
  • Phone: 401-944-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number435
License Number StateRI

VIII. Authorized Official

Name: MR. AKSHAY K TALWAR
Title or Position: ADMINISTRATOR
Credential: NHA JD CPA
Phone: 401-944-2450