Healthcare Provider Details

I. General information

NPI: 1982303566
Provider Name (Legal Business Name): MSA SMITHFIELD OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 PLEASANT VIEW AVE
SMITHFIELD RI
02917-1792
US

IV. Provider business mailing address

171 PLEASANT VIEW AVE
SMITHFIELD RI
02917-1792
US

V. Phone/Fax

Practice location:
  • Phone: 401-232-5577
  • Fax: 401-232-0225
Mailing address:
  • Phone: 401-232-5577
  • Fax: 401-232-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY J VAUGHN
Title or Position: REIMBURSEMENT ANALYST
Credential:
Phone: 240-882-9712