41D0658497 CLIA NUMBER - HATTIE IDE CHAFFEE NURSING HOME

Laboratory Demographics

  • CLIA Code: 41D0658497
  • Facility Name: HATTIE IDE CHAFFEE NURSING HOME
  • Facility Address: 200 WAMPANOAG TRAIL
    EAST PROVIDENCE, RI
    ZIP 02915
  • Facility Phone: 401 434-1520
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BARRY B. ZELTZER
  • NPI Number: 1700912458
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 41D0658497
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HATTIE IDE CHAFFEE NURSING HOME
Street 200 WAMPANOAG TRAIL
City EAST PROVIDENCE
State RI
ZIP 02915
Phone 401 434-1520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director BARRY B. ZELTZER

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This page was last updated on: 9/29/2025