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Organization
642 METACOM AVENUE OPERATIONS LLC
Active
Organization
642 METACOM AVENUE OPERATIONS LLC
Active
Other names
Warren Skilled Nursing and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
642 METACOM AVE, WARREN, RI 02885-2350
(401) 245-2860
(401) 245-0959
Mailing address
642 METACOM AVE, WARREN, RI 02885-2350
(401) 245-2860
(401) 245-0959
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
LTC00733
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MA75166
—
RI
Enumeration date
10/02/2008
Last updated
01/22/2024
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