Provider Demographics
NPI:1356338248
Name:BETHANY HOME OF RHODE ISLAND
Entity type:Organization
Organization Name:BETHANY HOME OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-831-2870
Mailing Address - Street 1:111 SOUTH ANGELL STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5397
Mailing Address - Country:US
Mailing Address - Phone:401-831-2870
Mailing Address - Fax:401-331-9570
Practice Address - Street 1:111 SOUTH ANGELL STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5397
Practice Address - Country:US
Practice Address - Phone:401-831-2870
Practice Address - Fax:401-331-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00531314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105096Medicaid
415096Medicare PIN