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General NPI Number Information
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NPI Number | 1093966608
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Entity Type | Organization
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Legal Business Name | 735 PUTNAM PIKE OPERATIONS LLC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 735 PUTNAM PIKE
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City | GREENVILLE
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State | RI
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Zip | 02828-1435
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Country | US
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Telephone | 401-949-1200
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Fax | 401-949-0968
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Provider Business Mailing Address
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Address Line | 735 PUTNAM PIKE
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City | GREENVILLE
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State | RI
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Zip | 02828-1435
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Country | US
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Telephone | 401-949-1200
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Fax | 401-949-0968
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Authorized Official
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Title or Position | SECRETARY
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Name | MICHAEL T BERG
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Credential |
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Telephone | 505-468-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | LTC00734
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License Number State | RI
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