South Bay Manor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SOUTH BAY MANOR

Practice address

1959 Kingstown Road
South Bay Retirement Living
South Kingstown, RI 02879-1608

Phone

(401) 789-5880

Fax

(401) 783-2880

NPI assigned

Aug 8, 2008

Organization subpart

No

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

Authorized official

Name

Mark Ohlendorf

Title

Chief Financial Officer (Cfo)

Phone

(414) 918-5403

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1881840932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST",
            "address_2": "SUITE 2300,",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53214",
            "telephone_number": "401-789-5880",
            "fax_number": "401-783-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 KINGSTOWN ROAD",
            "address_2": "SOUTH BAY RETIREMENT LIVING",
            "city": "SOUTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028791608",
            "telephone_number": "401-789-5880",
            "fax_number": "401-783-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-08",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "OHLENDORF",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER (CFO)",
        "authorized_official_telephone_number": "414-918-5403"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "RI",
            "license": null,
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "RI",
            "license": "LTC00735",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Amanda Stevens
• Antoinette O Sullivan, LICSW

• Assisted Living Facility in South Kingstown, RI
• Providers in South Kingstown, RI by specialty
• Assisted Living Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.