Provider Demographics
NPI:1659355519
Name:SAINT ELIZABETH MANOR EAST BAY
Entity Type:Organization
Organization Name:SAINT ELIZABETH MANOR EAST BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-253-2300
Mailing Address - Street 1:1 DAWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-3903
Mailing Address - Country:US
Mailing Address - Phone:401-253-2300
Mailing Address - Fax:401-254-1919
Practice Address - Street 1:1 DAWN HILL RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-3903
Practice Address - Country:US
Practice Address - Phone:401-253-2300
Practice Address - Fax:401-254-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00667314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI402364OtherBLUECHIP PROVIDER NUMBER
RI50407OtherBC/BS
MA6996931Medicaid
RISE48598Medicaid
RISE48598Medicaid