NPIMap

Organization Active NPI

Prospect Chartercare Elmhurst, LLC

  • Skilled Nursing Facility
  • Providence, RI
National Provider Identifier
1457776452
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
LTC00663 Issued in RI
Legal business name
PROSPECT CHARTERCARE ELMHURST, LLC
Practice address
50 Maude St
Providence, RI 02908-4325
Phone
(401) 456-2623
Fax
(401) 456-6862
NPI assigned
Feb 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X LTC00663 RI Primary

Addresses

Primary practice location

50 Maude St
Providence, RI 02908-4325

Mailing address

50 Maude St
Providence, RI 02908-4325
Phone (401) 456-2623

Other identifiers 1

IdentifierTypeStateIssuer
4105084MedicaidRI

Other names 1

  • Elmhurst Extended Care Facility Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elmhurst Extended Care Facility2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1077 Aquidneck Ave
#A
Middletown, RI 02842

420 Scrabbletown Rd
Ste H
North Kingstown, RI 02852
Phone (401) 295-5995

50 Maude St
Ste 3
Providence, RI 02908

41 Sanderson Rd
Ste 205
Smithfield, RI 02917
Phone (401) 349-0366

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1393459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1457776452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-2623",
            "fax_number": "401-456-6862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-2623",
            "fax_number": "401-456-6862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT CHARTERCARE ELMHURST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-27",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "RI",
            "license": "LTC00663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4105084",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elmhurst Extended Care Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elmhurst Extended Care Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 15, 2021; 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.