Provider Demographics
NPI:1811999576
Name:SCALLOP SHELL NURSING & REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:SCALLOP SHELL NURSING & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-789-3006
Mailing Address - Street 1:981 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEACE DALE
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3042
Mailing Address - Country:US
Mailing Address - Phone:401-789-3006
Mailing Address - Fax:401-789-3562
Practice Address - Street 1:981 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879-3042
Practice Address - Country:US
Practice Address - Phone:401-789-3006
Practice Address - Fax:401-789-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00352314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105057Medicaid
RI415057Medicare ID - Type Unspecified