Provider Demographics
NPI:1235112921
Name:EASTGATE NURSING AND RECOVERY CENTER INC.
Entity Type:Organization
Organization Name:EASTGATE NURSING AND RECOVERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMARAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-431-2087
Mailing Address - Street 1:198 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3523
Mailing Address - Country:US
Mailing Address - Phone:401-431-2087
Mailing Address - Fax:401-435-6465
Practice Address - Street 1:198 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3523
Practice Address - Country:US
Practice Address - Phone:401-431-2087
Practice Address - Fax:401-435-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00659314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5093OtherBLUE CROSS
RI402843OtherBLUE CHIP
RI7100042OtherUNITED HEALTH
RI4105083Medicaid
RI402843OtherBLUE CHIP
RI1069380001Medicare NSC