Provider Demographics
NPI:1902887029
Name:HEATHERWOOD NURSING AND REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:HEATHERWOOD NURSING AND REHABILITATION CENTER INC
Other - Org Name:HEATHERWOOD NURSING AND SUBACUTE CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACIOCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-849-6600
Mailing Address - Street 1:398 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-849-6600
Mailing Address - Fax:401-845-6600
Practice Address - Street 1:398 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-849-6600
Practice Address - Fax:401-845-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00679314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI415033Medicaid
RI415033Medicaid
RI415033Medicare UPIN