70 Gill Avenue Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

LTC00736 Issued in RI

Legal business name

70 GILL AVENUE OPERATIONS LLC

Practice address

70 Gill Ave
Pawtucket, RI 02861-4315

Phone

(401) 722-7900

Fax

(401) 723-9670

NPI assigned

Oct 2, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T Berg

Title

Corporate Officer

Phone

(505) 468-4742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pawtucket Skilled Nursing and Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1184875791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 GILL AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028614315",
            "telephone_number": "401-722-7900",
            "fax_number": "401-723-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 GILL AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028614315",
            "telephone_number": "401-722-7900",
            "fax_number": "401-723-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "70 GILL AVENUE OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CORPORATE OFFICER",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "RI",
            "license": "LTC00736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GA75165",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawtucket Skilled Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pawtucket Skilled Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Pawtucket, RI
• Skilled Nursing Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.