Provider Demographics
NPI:1528050499
Name:THE HOLIDAY RETIREMENT HOME, INC.
Entity type:Organization
Organization Name:THE HOLIDAY RETIREMENT HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EVERETTE
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, NHA
Authorized Official - Phone:401-765-1440
Mailing Address - Street 1:30 SAYLES HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02838-1227
Mailing Address - Country:US
Mailing Address - Phone:401-765-1440
Mailing Address - Fax:401-765-7464
Practice Address - Street 1:30 SAYLES HILL RD
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:RI
Practice Address - Zip Code:02838-1227
Practice Address - Country:US
Practice Address - Phone:401-765-1440
Practice Address - Fax:401-765-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI588314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4105075Medicaid
RIV631P3705OtherVETERANS ADMINISTRATION
RIV631P3705OtherVETERANS ADMINISTRATION