Organization Active NPI

Bethany Home of Rhode Island

  • Skilled Nursing Facility
  • Providence, RI
National Provider Identifier
1356338248
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
LTC00531 Issued in RI
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

Updated by the provider on Jul 1, 2022

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
4105096MedicaidRI

Electronic endpoints 1

TypeEndpointUseAffiliation
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 IDStateProvider typePAC IDDetails
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
CorporationNon-profit
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 IslandCCN 415096 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
May 21, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3329.3 residents per day on average
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D0084084Bethany Home of Rhode Island111 South Angell Street, Providence, RI 02906Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Bethany Home of Rhode Island Organization, Providence, RI Non-profit Operational/Managerial Control Mar 1, 2021
Stephanie Igoe Individual Corporate Officer Mar 1, 2021 100%
Operational/Managerial ControlAdministrator Mar 1, 2021 100%
Linda Wilson Individual 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

Verify at the official NPI Registry.