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Organization
PROSPECT CHARTERCARE ELMHURST, LLC
Active
Organization
PROSPECT CHARTERCARE ELMHURST, LLC
Active
Other names
Elmhurst Extended Care Facility
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-2623
(401) 456-6862
Mailing address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-2623
(401) 456-6862
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
LTC00663
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4105084
—
RI
Enumeration date
02/27/2014
Last updated
01/15/2021
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