Healthcare Provider Details

I. General information

NPI: 1184487290
Provider Name (Legal Business Name): FRIENDLY EDEN OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 RHODES AVE
WOONSOCKET RI
02895-2821
US

IV. Provider business mailing address

1904 AVENUE M
BROOKLYN NY
11230-6202
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-7220
  • Fax:
Mailing address:
  • Phone: 917-533-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS GELLIS
Title or Position: OWNER
Credential:
Phone: 917-533-7241