Healthcare Provider Details

I. General information

NPI: 1922982602
Provider Name (Legal Business Name): BRAVE ROOTS TURTLE POND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SAINT GEORGE CT
WARWICK RI
02888-5425
US

IV. Provider business mailing address

48 SAINT GEORGE CT
WARWICK RI
02888-5425
US

V. Phone/Fax

Practice location:
  • Phone: 516-384-0547
  • Fax:
Mailing address:
  • Phone: 516-384-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PIERRE
Title or Position: CEO
Credential: APN
Phone: 516-384-0547