Healthcare Provider Details

I. General information

NPI: 1144606807
Provider Name (Legal Business Name): 740 OAK HILL ROAD OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 OAK HILL ROAD
NORTH KINGSTOWN RI
02852
US

IV. Provider business mailing address

740 OAK HILL ROAD
NORTH KINGSTOWN RI
02852
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-4545
  • Fax: 401-294-4546
Mailing address:
  • Phone: 401-294-4545
  • Fax: 401-294-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00000
License Number StateRI

VIII. Authorized Official

Name: MICHAEL T BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4742