# INNOVATIVE SENIOR CARE HOME HEALTH OF RHODE ISLAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brookdale Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962140772
- **Authorized official:** NICHOLAS GACHASSIN III (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (337) 233-1307

## Contact information

- **Practice address:** 1215 MAIN RD, TIVERTON, RI 02878-4246
- **Practice address phone:** (844) 325-2702
- **Mailing address:** PO BOX 51266, LAFAYETTE, LA 70505-1266
- **Mailing address phone:** (337) 233-1307
- **Mailing address fax:** (337) 443-4154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 05/23/2022
- **Last updated:** 05/23/2022