Healthcare Provider Details

I. General information

NPI: 1215183884
Provider Name (Legal Business Name): MANCHESTER MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MANCHESTER ST
PAWTUCKET RI
02860-2016
US

IV. Provider business mailing address

12 MANCHESTER ST
PAWTUCKET RI
02860-2016
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-8390
  • Fax: 401-725-1359
Mailing address:
  • Phone: 401-725-8390
  • Fax: 401-725-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALR01315
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberALR01315
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberALR01315
License Number StateRI

VIII. Authorized Official

Name: FRANCES MAUREEN GOULET
Title or Position: OWNER/ADMINSTRATOR
Credential:
Phone: 401-725-8390