Provider Demographics
NPI:1457463077
Name:BERKSHIRE PLACE LTD.
Entity Type:Organization
Organization Name:BERKSHIRE PLACE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARROSO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA, BA
Authorized Official - Phone:401-553-8600
Mailing Address - Street 1:455 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2542
Mailing Address - Country:US
Mailing Address - Phone:401-553-8600
Mailing Address - Fax:401-553-8608
Practice Address - Street 1:455 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2542
Practice Address - Country:US
Practice Address - Phone:401-553-8600
Practice Address - Fax:401-553-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI695314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7101371OtherEVERCARE
RI402248OtherBLUE CHIP
RI4105119Medicaid
RI50836OtherBLUE CROSS
RI71-00004OtherUNITED HEALTH
RI415119Medicare ID - Type Unspecified