Healthcare Provider Details

I. General information

NPI: 1700912458
Provider Name (Legal Business Name): HATTIE IDE CHAFFEE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WAMPANOAG TRL
RIVERSIDE RI
02915-2206
US

IV. Provider business mailing address

200 WAMPANOAG TRL
RIVERSIDE RI
02915-2206
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-1520
  • Fax: 401-438-8494
Mailing address:
  • Phone: 401-434-1520
  • Fax: 401-438-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number223
License Number StateRI

VIII. Authorized Official

Name: MRS. DEBORAH M GRIFFIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-434-1520