Provider Demographics
NPI:1508864646
Name:ORCHARD VIEW MANOR , INC
Entity Type:Organization
Organization Name:ORCHARD VIEW MANOR , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BISBANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-438-2250
Mailing Address - Street 1:135 TRIPPS LN
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3017
Mailing Address - Country:US
Mailing Address - Phone:401-438-2250
Mailing Address - Fax:401-438-0635
Practice Address - Street 1:135 TRIPPS LN
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-3017
Practice Address - Country:US
Practice Address - Phone:401-438-2250
Practice Address - Fax:401-438-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00675314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI401096OtherBLUE CHIP
RI41-05059Medicaid
RI5064OtherBLUE CROSS
RI71-00111OtherUNITED HEALTHCARE
RI71-01086OtherEVERCARE
RI71-00111OtherUNITED HEALTHCARE