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General NPI Number Information
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NPI Number | 1144338476
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Entity Type | Organization
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Legal Business Name | JOHN CLARKE RETIREMENT CENTER
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 600 VALLEY RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-7014
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Country | US
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Telephone | 401-846-0743
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Fax | 401-848-5890
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Provider Business Mailing Address
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Address Line | 600 VALLEY RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-7014
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Country | US
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Telephone | 401-846-0743
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Fax | 401-848-5890
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOAN M. WOODS
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Credential | LNHA
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Telephone | 401-324-5424
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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 | LTC00634
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License Number State | RI
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