Healthcare Provider Details

I. General information

NPI: 1811402100
Provider Name (Legal Business Name): PROSPECT CHARTERCARE HOME HEALTH AND HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

IV. Provider business mailing address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2273
  • Fax:
Mailing address:
  • Phone: 401-456-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J. ELDERS
Title or Position: ASSISTANT SECRETARY
Credential: ESQ.
Phone: 714-788-1249