Healthcare Provider Details

I. General information

NPI: 1023535846
Provider Name (Legal Business Name): BELLA VITA ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WAMPANOAG TRL
RIVERSIDE RI
02915-3734
US

IV. Provider business mailing address

22 WAMPANOAG TRL
RIVERSIDE RI
02915-3734
US

V. Phone/Fax

Practice location:
  • Phone: 401-575-3645
  • Fax: 401-437-0338
Mailing address:
  • Phone: 401-575-3645
  • Fax: 401-437-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC00046
License Number StateRI

VIII. Authorized Official

Name: LISA LINDA BUONO
Title or Position: DIRECTOR
Credential: RN
Phone: 401-486-0882