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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