OrganizationActive
642 Metacom Avenue Operations LLC
NPI 1265683874 · Skilled Nursing Facility · Warren, RI
Provider details
- NPI number
- 1265683874
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Authorized official
- Michael Berg, Assistant Secretary
- License
- LTC00733 (RI)
Practice location
642 Metacom Ave
Warren, RI 02885-2350
Phone: (401) 245-2860
Fax: (401) 245-0959
Mailing address
642 Metacom Ave
Warren, RI 02885-2350
Registry dates
- Enumerated
- 2008-10-02
- Last updated
- 2024-01-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.