Healthcare Provider Details

I. General information

NPI: 1184714602
Provider Name (Legal Business Name): FOREST FARM HEALTH CARE CENTER I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 FOREST AVE
MIDDLETOWN RI
02842-4625
US

IV. Provider business mailing address

201 FOREST AVE
MIDDLETOWN RI
02842-4625
US

V. Phone/Fax

Practice location:
  • Phone: 401-847-2777
  • Fax: 401-848-7403
Mailing address:
  • Phone: 401-847-2777
  • Fax: 401-848-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00737
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALR01308
License Number StateRI

VIII. Authorized Official

Name: MR. KARL H LYON
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 401-847-2777