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General NPI Number Information
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NPI Number | 1154956969
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Entity Type | Organization
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Legal Business Name | ISLAND HEALTH AND REHAB LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 100 WAMPANOAG TRL
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City | RIVERSIDE
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State | RI
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Zip | 02915-3736
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Country | US
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Telephone | 401-438-4275
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WAMPANOAG TRL
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City | RIVERSIDE
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State | RI
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Zip | 02915-3736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FACILITY ADMINISTRATOR
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Credential |
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Telephone | 401-438-4275
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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 |
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License Number State |
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