Healthcare Provider Details

I. General information

NPI: 1295474534
Provider Name (Legal Business Name): 83 CORONA STREET EDEN OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CORONA ST
WARWICK RI
02886-1724
US

IV. Provider business mailing address

3118 QUENTIN RD
BROOKLYN NY
11234-4249
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-9193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS GELLIS
Title or Position: PRESIDENT & MEMBER
Credential:
Phone: 917-553-7241