Provider Demographics
NPI:1366561631
Name:TOCKWOTTON HOME
Entity type:Organization
Organization Name:TOCKWOTTON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-272-5280
Mailing Address - Street 1:500 WATERFRONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5047
Mailing Address - Country:US
Mailing Address - Phone:401-272-5280
Mailing Address - Fax:401-421-0550
Practice Address - Street 1:500 WATERFRONT DRIVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5047
Practice Address - Country:US
Practice Address - Phone:401-272-5280
Practice Address - Fax:401-421-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4105113314000000X
RIALR01360310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105113Medicaid
RI415113Medicare Oscar/Certification