MEDICARE: AVALON NURSING HOME 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	N446	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	:	1891776522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON NURSING HOME INC

Provider Business Mailing Address
First Line	:	57 STOKES ST
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-3425
Country	:	US
Telephone Number	:	401-738-1200
Fax Number	:	401-738-9430

Provider Business Practice Location Address
First Line	:	57 STOKES ST
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-3425
Country	:	US
Telephone Number	:	401-738-1200
Fax Number	:	401-738-9430

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	MR. DAVID STEPHEN KOWALIK
Credential	:
Telephone Number	:	401-738-1200

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	01/21/2020

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Directions to “AVALON NURSING HOME INC ” Practice Location

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