Provider Demographics
NPI:1083835300
Name:ST. JOSEPH LIVING CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH LIVING CENTER
Other - Org Name:ST. JOSEPH HEALTH SERVICES OF RI
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KEIMIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-272-3335
Mailing Address - Street 1:200 HIGH SERVICE AVE
Mailing Address - Street 2:4TH FL. MARION HALL
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-3309
Mailing Address - Fax:401-456-3762
Practice Address - Street 1:153 DEAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1603
Practice Address - Country:US
Practice Address - Phone:401-272-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01334310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIALR01334OtherLICENSE