Provider Demographics
NPI:1467945972
Name:RHODE ISLAND RESIDENTIAL ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:RHODE ISLAND RESIDENTIAL ASSISTED LIVING, LLC
Other - Org Name:COMMONWEALTH HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-298-6986
Mailing Address - Street 1:9 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2432
Mailing Address - Country:US
Mailing Address - Phone:401-368-1920
Mailing Address - Fax:
Practice Address - Street 1:655 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2788
Practice Address - Country:US
Practice Address - Phone:401-298-6986
Practice Address - Fax:401-889-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR1493310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility