1902883275 NPI number — PRIME HEALTHCARE SERVICES-LANDMARK LLC

Table of content: (NPI 1902883275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902883275 NPI number — PRIME HEALTHCARE SERVICES-LANDMARK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HEALTHCARE SERVICES-LANDMARK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REHABILITATION HOSPITAL OF RHODE ISLAND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902883275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 CASS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-4712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-769-4100
Provider Business Mailing Address Fax Number:
401-765-6024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 EDDIE DOWLING HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SMITHFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02896-7327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-766-0800
Provider Business Practice Location Address Fax Number:
401-762-3112
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHAREST
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
401-766-0800

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  02102 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000000035 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1102966 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000001938 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1210289 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP03025 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 906008 . This is a "TUFTS HEALTH PLAN (OP)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004713 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4103025 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 903936 . This is a "TUFTS HEALTH PLAN (IP)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 050473637 . This is a "TRICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5000236 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 902958 . This is a "HARVARD PILG;RIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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