Organization
HATTIE IDE CHAFFEE NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH M GRIFFIN (ADMINISTRATOR)
(401) 434-1520
Entity
Organization
Contact information
Practice address
200 WAMPANOAG TRL, RIVERSIDE, RI 02915-2206
(401) 434-1520
(401) 438-8494
Mailing address
200 WAMPANOAG TRL, RIVERSIDE, RI 02915-2206
(401) 434-1520
(401) 438-8494
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
223
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
401299
BLUE CHIP PROVIDER #
RI
05
—
4105002
—
RI
01
—
5024-7
BLUE CROSS BLUE SHIELD
RI
01
—
71-09045
UNITED HEALTHCARE
RI
Enumeration date
02/26/2007
Last updated
08/22/2020
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