Provider Demographics
NPI:1538158456
Name:BURRILLVILLE NURSING HOME INC
Entity type:Organization
Organization Name:BURRILLVILLE NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-568-3091
Mailing Address - Street 1:999 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-3522
Mailing Address - Country:US
Mailing Address - Phone:401-568-3091
Mailing Address - Fax:401-568-8070
Practice Address - Street 1:999 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-3522
Practice Address - Country:US
Practice Address - Phone:401-568-3091
Practice Address - Fax:401-568-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI601314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105099Medicaid
AR415099Medicare ID - Type Unspecified