=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356296222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPCO RI EAST GREENWICH - 945 MAIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 MAIN STREET
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-203-5461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 INTERNATIONAL CIRCLE SUITE 200
-----------------------------------------------------
City | HUNT VALLEY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF ACCOUNTING & FINANCE RE
-----------------------------------------------------
Name | MR. THOMAS J SEXTON
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 617-549-8507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------