Active NPI
Bethany Home of Rhode Island
- Skilled Nursing Facility
- Providence, RI
National Provider Identifier
1356338248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- LTC00531
- Legal business name
- BETHANY HOME OF RHODE ISLAND
- Practice address
- 111 South Angell Street
Providence, RI 02906-5397 - Phone
- (401) 831-2870
- Fax
- (401) 331-9570
- NPI assigned
- Oct 5, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Linda Christian Wilson
- Title
- Cfo
- Phone
- (401) 831-2870
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | LTC00531 | RI | Primary |
Addresses
Primary practice location
111 South Angell Street
Providence, RI 02906-5397
Mailing address
111 South Angell Street
Providence, RI 02906-5397
Phone (401) 831-2870
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4105096 | Medicaid | RI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 2.16.840.1.113883.3.667.2 | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071029000089 | RI | Part A Provider - Skilled Nursing Facility | 1951498674 | Practice locations: Providence, RI |
Skilled nursing facility certification: CCN 415096
- Legal name
- BETHANY HOME OF RHODE ISLAND
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 21, 1991
- Last certification
- Sep 26, 2024
- Beds
- 33
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Jan 1, 1892 in RI
- Enrollment address
- 111 S Angell St
Providence, RI 02906-5309 - Nursing home name
- BETHANY HOME OF RHODE ISLAND
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bethany Home of Rhode Island
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- May 21, 1991
- Medicare certification status
- Active
- Certified beds
- 33
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 41D0084084 | Bethany Home of Rhode Island | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Bethany Home of Rhode Island | Operational/Managerial Control | Mar 1, 2021 | |
| Stephanie Igoe | Corporate Officer | Mar 1, 2021 | 100% |
| Operational/Managerial Control | Mar 1, 2021 | 100% | |
| Linda Wilson | Corporate Director | Jan 1, 2021 |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1656633600000",
"number": "1356338248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 SOUTH ANGELL STREET",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065397",
"telephone_number": "401-831-2870",
"fax_number": "401-331-9570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 SOUTH ANGELL STREET",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065397",
"telephone_number": "401-831-2870",
"fax_number": "401-331-9570"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BETHANY HOME OF RHODE ISLAND",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-05",
"last_updated": "2022-07-01",
"certification_date": "2022-07-01",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "LINDA",
"authorized_official_middle_name": "CHRISTIAN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "401-831-2870"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "RI",
"license": "LTC00531",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4105096",
"state": "RI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "2.16.840.1.113883.3.667.2",
"affiliation": "Y",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "PROVIDENCE",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CMS esMD emDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.