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General NPI Number Information
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NPI Number | 1245654805
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Entity Type | Organization
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Legal Business Name | BELLA VILLA ASSISTED LIVING, INC
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 336 WILLETT AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915-3805
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Country | US
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Telephone | 401-437-0336
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Fax | 401-437-0338
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Provider Business Mailing Address
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Address Line | 336 WILLETT AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915
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Country | US
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Telephone | 401-437-0336
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Fax | 401-437-0338
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Authorized Official
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Title or Position | AL ADMINISTRATOR
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Name | LISA LINDA BUONO
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Credential | AL ADMINISTRATOR, RN
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Telephone | 401-486-0882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALR01486
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License Number State | RI
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