MEDICARE: SCALLOP SHELL NURSING & REHABILITATION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	LTC00352	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811999576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCALLOP SHELL NURSING & REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	981 KINGSTOWN RD
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-3042
Country	:	US
Telephone Number	:	401-789-3006
Fax Number	:	401-789-3562

Provider Business Practice Location Address
First Line	:	981 KINGSTOWN RD
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879-3042
Country	:	US
Telephone Number	:	401-789-3006
Fax Number	:	401-789-3562

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NEIL E. MAHONEY
Credential	:
Telephone Number	:	401-789-3006

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2020

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