642 Metacom Avenue Operations LLC
NPI #1265683874 in Warren, Rhode Island
Provider Information
- NPI Number
- 1265683874
- Entity Type
- Organization
- Organization Name
- 642 Metacom Avenue Operations LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Oct 2, 2008
- Last Updated
- Jan 22, 2024
Practice Location
- Address
- 642 METACOM AVE
- City
- Warren
- State
- Rhode Island
- ZIP Code
- 02885-2350
- Phone
- (401) 245-2860
Authorized Official
- Name
- MICHAEL T BERG
- Title
- ASSISTANT SECRETARY
- Phone
- (505) 468-4742
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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