Provider Demographics
NPI:1891776522
Name:AVALON NURSING HOME INC
Entity Type:Organization
Organization Name:AVALON NURSING HOME INC
Other - Org Name:AVALON NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KOWALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-1200
Mailing Address - Street 1:57 STOKES ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-3425
Mailing Address - Country:US
Mailing Address - Phone:401-738-1200
Mailing Address - Fax:401-738-9430
Practice Address - Street 1:57 STOKES ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-3425
Practice Address - Country:US
Practice Address - Phone:401-738-1200
Practice Address - Fax:401-738-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIN446314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105060Medicaid
RI415060Medicare ID - Type Unspecified