SHANNOCK ROAD GROUP HOME NPI 1912032079

NPI Information

NPI: 1912032079
Provider Name: SHANNOCK ROAD GROUP HOME
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
794 SHANNOCK RD
WAKEFIELD, RI
ZIP 02879
Phone: (401) 462-7829
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SHANNOCK ROAD GROUP HOME is a community based residential treatment facility, intellectual and/or developmental disabilities in Wakefield, RI. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SHANNOCK ROAD GROUP HOME NPI is 1912032079. The provider is registered as an organization entity type.

The provider's business location address is:

794 SHANNOCK RD
WAKEFIELD, RI
ZIP 02879-756
Phone: (401) 462-7829

The provider's authorized official is Ellen R Nelson .
The authorized official title is Director and has the following contact phone number (401) 462-6001.

The enumeration date for this NPI number is 2/22/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		15	RHODE ISLAND	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	LC01922	MEDICAID	RHODE ISLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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