Pawtucket SNF Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PAWTUCKET SNF OPERATOR LLC

Practice address

70 Gill Ave
Pawtucket, RI 02861-4315

Phone

(401) 722-7900

NPI assigned

Jul 22, 2020

Organization subpart

No

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

Authorized official

Name

Jeffrey Kagan

Title

Owner

Phone

(410) 877-6630

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1285242610",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWTUCKET SNF OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-22",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "KAGAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-877-6630"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.