Provider Demographics
NPI:1144606807
Name:740 OAK HILL ROAD OPERATIONS LLC
Entity Type:Organization
Organization Name:740 OAK HILL ROAD OPERATIONS LLC
Other - Org Name:SOUTH COUNTY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:740 OAK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-294-4545
Mailing Address - Fax:401-294-4546
Practice Address - Street 1:740 OAK HILL ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-294-4545
Practice Address - Fax:401-294-4546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility