1356306757 NPI number — OAKLAND GROVE ASSOCIATES LP

Table of content: (NPI 1356306757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356306757 NPI number — OAKLAND GROVE ASSOCIATES LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKLAND GROVE ASSOCIATES LP
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:
6
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:
1356306757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 CUMBERLAND HILL RD
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:
02895-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-769-0800
Provider Business Mailing Address Fax Number:
401-766-3661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 CUMBERLAND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-769-0800
Provider Business Practice Location Address Fax Number:
401-766-3661
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTILLI
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
SOLE MANAGER
Authorized Official Telephone Number:
860-751-3900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  LTC00718 , 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: 4105110 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7101330 . This is a "EVERCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 204077 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7109059 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 50809 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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