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General NPI Number Information
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NPI Number | 1265752737
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Entity Type | Organization
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Legal Business Name | DARLINGTON MEMORY LANE
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 1081 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4101
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Country | US
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Telephone | 401-225-9257
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Fax |
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Provider Business Mailing Address
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Address Line | 1081 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4101
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Country | US
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Telephone | 401-225-9257
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARGARET BUBIS
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Credential | ADM
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Telephone | 401-228-9257
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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 | 00185
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License Number State | RI
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