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General NPI Number Information
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NPI Number | 1962726034
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Entity Type | Organization
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Legal Business Name | OCEAN STATE ASSISTED LIVING
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 5 SAINT ELIZABETH WAY
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City | EAST GREENWICH
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State | RI
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Zip | 02818-2164
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Country | US
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Telephone | 401-884-9099
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Fax | 401-884-7439
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Provider Business Mailing Address
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Address Line | 5 SAINT ELIZABETH WAY
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City | EAST GREENWICH
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State | RI
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Zip | 02818-2164
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Country | US
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Telephone | 401-884-9099
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Fax | 401-884-7439
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN CHRISTIAN WOULFE
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Credential |
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Telephone | 401-884-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | ALR001419
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALR01419
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License Number State | RI
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