Provider Demographics
NPI:1043337330
Name:CORTLAND PLACE HEALTH CENTER, INC
Entity Type:Organization
Organization Name:CORTLAND PLACE HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUDINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-949-3880
Mailing Address - Street 1:20 AUSTIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828
Mailing Address - Country:US
Mailing Address - Phone:401-949-3880
Mailing Address - Fax:401-949-4170
Practice Address - Street 1:20 AUSTIN AVENUE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828
Practice Address - Country:US
Practice Address - Phone:401-949-3880
Practice Address - Fax:401-949-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01379310400000X
RILTC00704314000000X
RI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5432, 402017, 5309OtherRHODE ISLAND BLUECROSS
7109172OtherUNITED HEALTHCARE
RI4105123Medicaid
RI5432, 402017, 5309OtherRHODE ISLAND BLUECROSS