Healthcare Provider Details

I. General information

NPI: 1437114436
Provider Name (Legal Business Name): SAINT ELIZABETH AT HOME CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 WICKENDEN ST
PROVIDENCE RI
02903-4422
US

IV. Provider business mailing address

249 WICKENDEN ST
PROVIDENCE RI
02903-4422
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-9660
  • Fax: 401-831-2157
Mailing address:
  • Phone: 401-751-9660
  • Fax: 401-831-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2204
License Number StateRI

VIII. Authorized Official

Name: CAROLINE M RUMOWICZ
Title or Position: DIRECTOR
Credential:
Phone: 401-751-9660