Provider Demographics
NPI:1003897828
Name:WOODLAND CONVALESCENT CENTER INC
Entity Type:Organization
Organization Name:WOODLAND CONVALESCENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBRUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-765-0499
Mailing Address - Street 1:70 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-8204
Mailing Address - Country:US
Mailing Address - Phone:401-765-0499
Mailing Address - Fax:401-765-1225
Practice Address - Street 1:70 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8204
Practice Address - Country:US
Practice Address - Phone:401-765-0499
Practice Address - Fax:401-765-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00580314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105103Medicaid
RI50742OtherBLUE CROSS/BLUE SHIELD
RI412727OtherBLUECHIP HEALTH PLAN
0550090001OtherNSC
RI4105103Medicaid