Provider Demographics
NPI:1407954126
Name:FLORA LEDGE LLC
Entity Type:Organization
Organization Name:FLORA LEDGE LLC
Other - Org Name:DBA WOODPECKER HILL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:COUTURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-397-7504
Mailing Address - Street 1:2052 PLAINFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CPU SUMMIT GENERAL STORE
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1908
Mailing Address - Country:US
Mailing Address - Phone:401-397-7504
Mailing Address - Fax:401-397-2514
Practice Address - Street 1:2052 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CPU SUMMIT GENERAL STORE
Practice Address - State:RI
Practice Address - Zip Code:02827-1908
Practice Address - Country:US
Practice Address - Phone:401-397-7504
Practice Address - Fax:401-397-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00726314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105839Medicaid
RI41-5105Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER