Provider Demographics
NPI:1831443779
Name:ATHENA ORCHARD VIEW LLC
Entity type:Organization
Organization Name:ATHENA ORCHARD VIEW 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 1:135 TRIPPS LANE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3017
Mailing Address - Country:US
Mailing Address - Phone:401-438-2250
Mailing Address - Fax:401-438-0635
Practice Address - Street 1:135 TRIPPS LANE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-3017
Practice Address - Country:US
Practice Address - Phone:401-438-2250
Practice Address - Fax:401-438-0635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAT94610Medicaid