642 Metacom Avenue Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

LTC00733 Issued in RI

Legal business name

642 METACOM AVENUE OPERATIONS LLC

Doing business as

Warren Skilled Nursing and Rehabilitation

Practice address

642 Metacom Ave
Warren, RI 02885-2350

Phone

(401) 245-2860

Fax

(401) 245-0959

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

Assistant Secretary

Phone

(505) 468-4742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Warren Skilled Nursing and Rehabilitation Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1265683874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 METACOM AVE",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028852350",
            "telephone_number": "401-245-2860",
            "fax_number": "401-245-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 METACOM AVE",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028852350",
            "telephone_number": "401-245-2860",
            "fax_number": "401-245-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "642 METACOM AVENUE OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "RI",
            "license": "LTC00733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MA75166",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warren Skilled Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Gail Abbruzzi
• Karen Abramson, RN
• Adviniacare at Warren LLC
• Melissa Agonia, PHARMD
• Maria L Aguiar, MSW LICSW

• Skilled Nursing Facility in Warren, RI
• Providers in Warren, RI by specialty
• Skilled Nursing Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.