Provider Demographics
NPI:1952814311
Name:CHARLESGATE SENIOR LIVING CENTER
Entity Type:Organization
Organization Name:CHARLESGATE SENIOR LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-453-9331
Mailing Address - Street 1:100 RANDALL STREET
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-861-5858
Mailing Address - Fax:401-490-3464
Practice Address - Street 1:670 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-453-9317
Practice Address - Fax:401-453-9323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLESGATE NORTH APARTMENTS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-08
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01499310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIALR01499OtherSTATE ISSUED OPERATING LICENSE