=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033151345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN HEALTH CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 MORGAN AVE
-----------------------------------------------------
City | JOHNSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-944-7800
-----------------------------------------------------
Fax | 401-944-6037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 588 PAWTUCKET AVE
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02860-6057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-751-3800
-----------------------------------------------------
Fax | 401-751-6350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | KELLY ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-751-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 622
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------