Provider Demographics
NPI:1134222441
Name:STATEWIDE HEALTH SERVICES INC
Entity type:Organization
Organization Name:STATEWIDE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN 16150 REGISTERED
Authorized Official - Phone:401-738-7775
Mailing Address - Street 1:2905 POST RD
Mailing Address - Street 2:STE 5
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3174
Mailing Address - Country:US
Mailing Address - Phone:401-738-7775
Mailing Address - Fax:401-737-0414
Practice Address - Street 1:2905 POST RD
Practice Address - Street 2:STE 5
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3174
Practice Address - Country:US
Practice Address - Phone:401-738-7775
Practice Address - Fax:401-737-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHCP02436251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5W55741Medicaid
RI5W55742Medicaid