Provider Demographics
NPI:1649273830
Name:HEBERT NURSING HOME INC
Entity type:Organization
Organization Name:HEBERT NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-231-7016
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:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI264314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI402577OtherBLUE CHIP
RI5088-1OtherBLUE CROSS & BLUE SHIELD
RI7109090OtherUNITED HEALTHCARE OF NE
RI410549Medicaid
RI410549Medicaid