Healthcare Provider Details

I. General information

NPI: 1326032772
Provider Name (Legal Business Name): BALLOU HOME FOR THE AGED OF WOONSOCKET RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MENDON RD
WOONSOCKET RI
02895-1512
US

IV. Provider business mailing address

60 MENDON RD
WOONSOCKET RI
02895-1512
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-0437
  • Fax: 401-769-7481
Mailing address:
  • Phone: 401-769-0437
  • Fax: 401-769-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number525
License Number StateRI

VIII. Authorized Official

Name: CARL O NEWELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 401-769-0437