Healthcare Provider Details

I. General information

NPI: 1629070206
Provider Name (Legal Business Name): ST. CLARE HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SPRING ST
NEWPORT RI
02840-6816
US

IV. Provider business mailing address

309 SPRING ST
NEWPORT RI
02840-6816
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-3204
  • Fax: 401-849-5780
Mailing address:
  • Phone: 401-849-3204
  • Fax: 401-849-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC00004
License Number StateRI

VIII. Authorized Official

Name: MRS. LAURA DOS SANTOS
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-849-3204