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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