Healthcare Provider Details

I. General information

NPI: 1003818063
Provider Name (Legal Business Name): HOPKINS MANOR, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SMITHFIELD ROAD
NORTH PROVIDENCE RI
02904-3899
US

IV. Provider business mailing address

610 SMITHFIELD ROAD
NORTH PROVIDENCE RI
02904-3899
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-6300
  • Fax: 401-353-8165
Mailing address:
  • Phone: 401-353-6300
  • Fax: 401-353-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number596
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number598
License Number StateRI

VIII. Authorized Official

Name: MR. MARK STEVEN LEVESQUE
Title or Position: ADMINISTRATOR
Credential: MS, NHA
Phone: 401-353-6300