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General NPI Number Information
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NPI Number | 1467945972
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Entity Type | Organization
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Legal Business Name | RHODE ISLAND RESIDENTIAL ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 655 COMMONWEALTH AVE
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City | WARWICK
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State | RI
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Zip | 02886-2788
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Country | US
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Telephone | 401-298-6986
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Fax | 401-889-3670
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Provider Business Mailing Address
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Address Line | 9 SOMERSET AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-2432
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Country | US
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Telephone | 401-368-1920
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. AMANDA RAE WILLOUGHBY
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Credential |
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Telephone | 401-298-6986
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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 | ALR1493
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License Number State | RI
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