Provider Demographics
NPI:1053313791
Name:WATERVIEW RI SNF, LLC
Entity Type:Organization
Organization Name:WATERVIEW RI SNF, LLC
Other - Org Name:WATERVIEW VILLA REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:1275 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4932
Mailing Address - Country:US
Mailing Address - Phone:401-438-7020
Mailing Address - Fax:401-438-0013
Practice Address - Street 1:1275 S BROADWAY
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4932
Practice Address - Country:US
Practice Address - Phone:401-438-7020
Practice Address - Fax:401-438-0013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE SYSTEMS RI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIC610314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIWA85796Medicaid
RI415042Medicare Oscar/Certification