Organization
981 KINGS TOWN ROAD OPERATING COMPANY, LLC
Active
Other names
Elderwood of Scallop Shell at Wakefield
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY RUBIN (CO-CHIEF EXECUTIVE OFFICER)
(716) 817-5075
Entity
Organization
Contact information
Practice address
55 SCALLOP SHELL WAY, PEACE DALE, RI 02879-3045
(401) 789-3006
Mailing address
500 SENECA ST STE 100, BUFFALO, NY 14204-1963
(716) 633-3900
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC00352
RHODE ISLAND DEPARTMENT OF HEALTH
RI
Enumeration date
11/15/2010
Last updated
01/19/2023
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