Healthcare Provider Details

I. General information

NPI: 1205956794
Provider Name (Legal Business Name): THE WILLOWS, AN ASSISTED LIVING AND ADULT DAY CARE COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BARKER AVE
WARREN RI
02885-2027
US

IV. Provider business mailing address

47 BARKER AVE
WARREN RI
02885-2027
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-2323
  • Fax: 401-247-9030
Mailing address:
  • Phone: 401-245-2323
  • Fax: 401-247-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number11
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number01383
License Number StateRI

VIII. Authorized Official

Name: MR. MARK CHRISTOPHER LESCAULT
Title or Position: PRESIDENT
Credential: AS,BS,MBA,ADM,ALA
Phone: 401-245-2323