Healthcare Provider Details

I. General information

NPI: 1568009520
Provider Name (Legal Business Name): SHI-II WARWICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 TOLLGATE HILL FARM RD
WARWICK RI
02886-4495
US

IV. Provider business mailing address

C/O KAPLAN DEVELOPMENT GROUP 100 JERICHO QUADRANGLE, SUITE 142
JERICHO NY
11753
US

V. Phone/Fax

Practice location:
  • Phone: 401-889-5905
  • Fax: 401-889-5906
Mailing address:
  • Phone: 516-496-1505
  • Fax:

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

VIII. Authorized Official

Name: MR. RAYMOND T DIOGUARDI
Title or Position: COO/CFO
Credential:
Phone: 516-496-1505