Provider Demographics
NPI:1902883275
Name:PRIME HEALTHCARE SERVICES-LANDMARK LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES-LANDMARK LLC
Other - Org Name:REHABILITATION HOSPITAL OF RHODE ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-766-0800
Mailing Address - Street 1:196 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-765-6024
Practice Address - Street 1:116 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7327
Practice Address - Country:US
Practice Address - Phone:401-766-0800
Practice Address - Fax:401-762-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02102283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000000035OtherBLUE CROSS
MA1102966Medicaid
RI000000001938OtherNEIGHBORHOOD HEALTH PLAN
MA1210289Medicaid
RIOP03025Medicaid
MA906008OtherTUFTS HEALTH PLAN (OP)
RI004713OtherBLUE CHIP
RI4103025Medicaid
MA903936OtherTUFTS HEALTH PLAN (IP)
RI050473637OtherTRICARE
RI5000236OtherUNITED HEALTHCARE
MA902958OtherHARVARD PILG;RIM HEALTH
RI0000000035OtherBLUE CROSS