Provider Demographics
NPI:1093786071
Name:FRIENDLY HOME INC
Entity Type:Organization
Organization Name:FRIENDLY HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-769-7220
Mailing Address - Street 1:303 RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2899
Mailing Address - Country:US
Mailing Address - Phone:401-769-7220
Mailing Address - Fax:401-766-8282
Practice Address - Street 1:303 RHODES AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-2899
Practice Address - Country:US
Practice Address - Phone:401-769-7220
Practice Address - Fax:401-766-8282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRIENDLY HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-30
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI631314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105044Medicaid
RI4105044Medicaid