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General NPI Number Information
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NPI Number | 1417164096
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Entity Type | Organization
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Legal Business Name | VILLAGE AT WATERMAN LAKE
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 715 PUTNAM PIKE
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City | GREENVILLE
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State | RI
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Zip | 02828-1428
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Country | US
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Telephone | 401-949-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 715 PUTNAM PIKE
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City | GREENVILLE
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State | RI
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Zip | 02828-1428
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Country | US
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Telephone | 401-949-4333
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Fax |
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Authorized Official
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Title or Position | CONTOLLER
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Name | MS. ROBERTA BURLEY
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Credential |
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Telephone | 401-949-4333
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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 | ALR01347
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License Number State | RI
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