Healthcare Provider Details

I. General information

NPI: 1154956969
Provider Name (Legal Business Name): ISLAND HEALTH AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WAMPANOAG TRL
RIVERSIDE RI
02915-3736
US

IV. Provider business mailing address

100 WAMPANOAG TRL
RIVERSIDE RI
02915-3736
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-4275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FACILITY ADMINISTRATOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-438-4275