Organization
SHADY ACRES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WILLIAM MIGA (PRESIDENT/ADMINISTRATOR)
(401) 295-8540
Entity
Organization
Contact information
Practice address
415 GARDNER RD, WEST KINGSTON, RI 02892-1047
(401) 295-8520
(401) 294-1050
Mailing address
415 GARDNER RD, WEST KINGSTON, RI 02892-1047
(401) 295-8520
(401) 294-1050
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
608
RI
314000000X
Skilled Nursing Facility
Primary
608
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
402416
BLUE CHIP
RI
05
—
4105107
—
RI
01
—
71-0005
UNITED HEALTHCARE
RI
Enumeration date
09/07/2005
Last updated
09/10/2014
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