Provider Demographics
NPI:1710208590
Name:ASLC RI II LLC
Entity Type:Organization
Organization Name:ASLC RI II LLC
Other - Org Name:HEBERTS NURSING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-398-7131
Mailing Address - Street 1:180 LOG RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1518
Mailing Address - Country:US
Mailing Address - Phone:401-231-7016
Mailing Address - Fax:401-231-4018
Practice Address - Street 1:180 LOG RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1518
Practice Address - Country:US
Practice Address - Phone:401-231-7016
Practice Address - Fax:401-231-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00767314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILTC00767Medicaid
415049Medicare Oscar/Certification