Healthcare Provider Details

I. General information

NPI: 1467732370
Provider Name (Legal Business Name): SH OPCO WEST BAY MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 W SHORE RD
WARWICK RI
02889-8659
US

IV. Provider business mailing address

2783 W SHORE RD
WARWICK RI
02889-8659
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-7300
  • Fax: 401-738-3488
Mailing address:
  • Phone: 401-739-7300
  • Fax: 401-738-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateRI

VIII. Authorized Official

Name: MARK W OHLENDORF
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5000