Active NPI
Scandinavian Home Inc
- Skilled Nursing Facility
- Cranston, RI
National Provider Identifier
1922031665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 00390
- Legal business name
- SCANDINAVIAN HOME INC
- Practice address
- 1811 Broad St
Cranston, RI 02905-3533 - Phone
- (401) 461-1433
- Fax
- (401) 461-4005
- NPI assigned
- Jul 8, 2006
- 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
- Mrs. Linda Tucker
- Title
- Administrator
- Phone
- (401) 461-1433
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 00390 | RI | Primary |
Addresses
Primary practice location
1811 Broad St
Cranston, RI 02905-3533
Mailing address
1811 Broad Street
Cranston, RI 02905
Phone (401) 461-1433
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 740800 | Other | RI | UNITED HEALTH PROVIDER NU |
| 405363 | Other | RI | BLUE CHIP PROVIDER NUMBER |
| 54375 | Other | RI | BLUE CROSS PROVIDER NUMBE |
| 4105051 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071207000514 | RI | Part A Provider - Skilled Nursing Facility | 4981793320 | Practice locations: Cranston, RI |
Skilled nursing facility certification: CCN 415051
- Legal name
- SCANDINAVIAN HOME INC
- Certification status
- Active
- Provider type (POS)
- Nursing home โ SNF/NF dual certification
- Participating since
- Jul 1, 1977
- Last certification
- Nov 7, 2024
- Beds
- 74
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- May 12, 1930 in RI
- Enrollment address
- 1811 Broad Street
Cranston, RI 02905-3533 - Nursing home name
- SCANDINAVIAN HOME INC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Scandinavian Home Inc
- Overall star rating
- Health inspections
- Staffing
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jul 1, 1977
- Medicare certification status
- Active
- Certified beds
- 74
National Provider Directory
National Provider Directory- Tax ID family
- Scandinavian Home Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Assisted Living Facility
- Cranston, RI
- NPI 1245553775
Ownership & related parties
All disclosed owners & managing parties 14
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 |
|---|---|---|---|
| Donald Forster | Corporate Officer | Jun 1, 2020 | |
| Colette Silverman | Corporate Officer | Jan 1, 2019 | |
| W-2 Managing Employee | Jan 1, 2019 | 100% | |
| Paul a Swanson | Corporate Officer | Jun 1, 2020 | |
| Thomas Pearson | Corporate Officer | Jun 1, 2020 | |
| Jean Larkin | Corporate Officer | Jun 1, 2020 | |
| Ronald S Ohsberg | Corporate Officer | Jun 1, 2020 | |
| Taiwo Sodipo | W-2 Managing Employee | Jul 1, 2019 | |
| Leif Reslow | Corporate Officer | Jun 1, 2020 | |
| Joel Johnson | Corporate Officer | Jun 1, 2020 | |
| Julie Carroccia | Corporate Officer | Jun 1, 2020 | |
| Margaret Mock | Corporate Officer | Jun 1, 2020 | |
| Doris Connor | Corporate Director | Jun 1, 2020 | |
| Andrew Nault | Corporate Officer | Jun 1, 2020 | |
| Katherine Desimone | Corporate Officer | Jun 1, 2020 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1201046400000",
"number": "1922031665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1811 BROAD STREET",
"city": "CRANSTON",
"state": "RI",
"postal_code": "02905",
"telephone_number": "401-461-1433",
"fax_number": "401-461-4005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1811 BROAD ST",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029053533",
"telephone_number": "401-461-1433",
"fax_number": "401-461-4005"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SCANDINAVIAN HOME INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-08",
"last_updated": "2008-01-23",
"status": "A",
"authorized_official_last_name": "TUCKER",
"authorized_official_first_name": "LINDA",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "401-461-1433",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "RI",
"license": "00390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH PROVIDER NU",
"identifier": "740800",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP PROVIDER NUMBER",
"identifier": "405363",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "54375",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4105051",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Cranston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; 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.