Healthcare Provider Details

I. General information

NPI: 1902887029
Provider Name (Legal Business Name): HEATHERWOOD NURSING AND REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 BELLEVUE AVE
NEWPORT RI
02840
US

IV. Provider business mailing address

398 BELLEVUE AVE
NEWPORT RI
02840
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-6600
  • Fax: 401-845-6600
Mailing address:
  • Phone: 401-849-6600
  • Fax: 401-845-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC00679
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier415033
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer

VIII. Authorized Official

Name: MRS. CINDY A MACIOCI
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-849-6600