Provider Demographics
NPI:1437155546
Name:SOUTH COUNTY NURSING AND REHABILITATION CENTER
Entity type:Organization
Organization Name:SOUTH COUNTY NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRBANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-294-4545
Mailing Address - Street 1:740 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-7205
Mailing Address - Country:US
Mailing Address - Phone:401-294-4545
Mailing Address - Fax:401-295-7650
Practice Address - Street 1:740 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7205
Practice Address - Country:US
Practice Address - Phone:401-294-4545
Practice Address - Fax:401-295-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC678313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI41-5071Medicare ID - Type Unspecified