Healthcare Provider Details

I. General information

NPI: 1831185198
Provider Name (Legal Business Name): PEZZELLI NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SMITHFIELD RD
NORTH PROVIDENCE RI
02904-5311
US

IV. Provider business mailing address

100 SMITHFIELD RD
NORTH PROVIDENCE RI
02904-5311
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-1710
  • Fax: 401-353-1618
Mailing address:
  • Phone: 401-353-1710
  • Fax: 401-353-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number543
License Number StateRI

VIII. Authorized Official

Name: MR. PAUL M PEZZELLI
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 401-353-1710