1437114436 NPI number — SAINT ELIZABETH AT HOME CORP

Table of content: (NPI 1437114436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437114436 NPI number — SAINT ELIZABETH AT HOME CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT ELIZABETH AT HOME CORP
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:
1437114436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 WICKENDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-751-9660
Provider Business Mailing Address Fax Number:
401-831-2157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 WICKENDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-751-9660
Provider Business Practice Location Address Fax Number:
401-831-2157
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUMOWICZ
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
401-751-9660

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  2204 , 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: 4107038 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5833-7 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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