Provider Demographics
NPI:1184892374
Name:SUMMIT RI SNF, LLC
Entity type:Organization
Organization Name:SUMMIT RI SNF, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2943
Mailing Address - Country:US
Mailing Address - Phone:401-574-4800
Mailing Address - Fax:401-278-4937
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2943
Practice Address - Country:US
Practice Address - Phone:401-278-4934
Practice Address - Fax:401-278-4937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE SYSTEMS RI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00754314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISU85797Medicaid
RI415129Medicare Oscar/Certification