Provider Demographics
NPI:1073554812
Name:BURRILLVILLE HEALTH CENTER
Entity Type:Organization
Organization Name:BURRILLVILLE HEALTH CENTER
Other - Org Name:BAYBERRY COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:401-568-0600
Mailing Address - Street 1:181 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-3507
Mailing Address - Country:US
Mailing Address - Phone:401-568-0600
Mailing Address - Fax:401-568-3080
Practice Address - Street 1:181 DAVIS DR
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-3507
Practice Address - Country:US
Practice Address - Phone:401-568-0600
Practice Address - Fax:401-568-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00651313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
7101152OtherEVERCARE
401581OtherBLUE CHIP
7100105OtherUNITED HEALTH PLAN
RI4105080Medicaid
RI4105080Medicaid