Healthcare Provider Details

I. General information

NPI: 1801478748
Provider Name (Legal Business Name): HALCYON AT WEST BAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
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: 740-491-8721
  • Fax:
Mailing address:
  • Phone: 740-491-8721
  • 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: MRS. CHARITY ANN STACKHOUSE
Title or Position: DIRECTOR OF OPERATIONS
Credential: LNHA
Phone: 740-491-8721