Provider Demographics
NPI:1811949068
Name:NANCY ANN NURSING HOME, INC.
Entity type:Organization
Organization Name:NANCY ANN NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-647-2170
Mailing Address - Street 1:47 E KILLINGLY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1429
Mailing Address - Country:US
Mailing Address - Phone:401-647-2170
Mailing Address - Fax:401-647-9020
Practice Address - Street 1:47 E KILLINGLY RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1429
Practice Address - Country:US
Practice Address - Phone:401-647-2170
Practice Address - Fax:401-647-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI410-5115314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105115Medicaid
RI415115Medicare ID - Type Unspecified