Provider Demographics
NPI:1487664504
Name:JACQUELINE ANNE SILVA
Entity Type:Organization
Organization Name:JACQUELINE ANNE SILVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-792-0011
Mailing Address - Street 1:75 NEWMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1945
Mailing Address - Country:US
Mailing Address - Phone:401-453-0666
Mailing Address - Fax:401-453-9619
Practice Address - Street 1:960 BOSTON NECK RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-1714
Practice Address - Country:US
Practice Address - Phone:401-792-1199
Practice Address - Fax:401-792-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4413290001Medicare NSC