THE TAVARES PEDIATRIC CENTER INC
Intermediate Care Facility, Mentally Retarded
Providence, Rhode Island
Provider NPI: 1366442899
Organization Information:Organization Name: THE TAVARES PEDIATRIC CENTER INC
Practice Location:
101 PLAIN ST PROVIDENCE, RI 02903 US
Tel: 401-272-7127 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
101 PLAIN ST PROVIDENCE, RI 02903 US
Tel: 401-272-7127 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
X | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | RI | RI 642 |
X | 314000000X | Nursing & Custodial Care Facilities Skilled Nursing Facility | RI | RI 642 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
41G085 | RI | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin