1164462818 NPI number — GRACE BARKER NURSING CENTER INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164462818 NPI number — GRACE BARKER NURSING CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE BARKER NURSING CENTER INC.
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:
Provider Other Organization Name Type Code:
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:
1164462818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 BARKER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02885-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-245-9100
Provider Business Mailing Address Fax Number:
401-245-3730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 BARKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02885-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-245-9100
Provider Business Practice Location Address Fax Number:
401-245-3730
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LESCAULT
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
ELIAS
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
401-245-9100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  692 , 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)





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