Healthcare Provider Details

I. General information

NPI: 1033151519
Provider Name (Legal Business Name): VILLAGE HOUSE CONVALESCENT HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 HARRISON AVE
NEWPORT RI
02840-3879
US

IV. Provider business mailing address

70 HARRISON AVE
NEWPORT RI
02840-3879
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-5222
  • Fax: 401-849-5765
Mailing address:
  • Phone: 401-849-5222
  • Fax: 401-849-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number589
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number589
License Number StateRI

VIII. Authorized Official

Name: KELLY ARNOLD
Title or Position: COO
Credential:
Phone: 401-751-3800