Provider Demographics
NPI:1497721203
Name:BRENTWOOD HEALTH CENTER, LTD
Entity Type:Organization
Organization Name:BRENTWOOD HEALTH CENTER, LTD
Other - Org Name:BRENTWOOD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMISSION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-884-8020
Mailing Address - Street 1:4000 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9200
Mailing Address - Country:US
Mailing Address - Phone:401-884-8020
Mailing Address - Fax:401-884-7977
Practice Address - Street 1:4000 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-9200
Practice Address - Country:US
Practice Address - Phone:401-884-8020
Practice Address - Fax:401-884-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI000731314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI415061Medicare ID - Type UnspecifiedPROVIDER NUMBER