NPI 1336513811

Src Providence, LLC

Organisation Skilled Nursing Facility Providence, RI

Practice location

Address: 353 Blackstone Blvd, Providence, RI 02906-4936
Phone: (401) 273-6565
Mailing address: 63 Kendrick St, Needham, MA 02494-2708

Authorised official

Name: Tamilyn Levin
Title: Chief Financial Officer
Phone: (781) 707-9510

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X

Other Skilled Nursing Facility providers in Rhode Island →

Registry record

NPI: 1336513811
Entity type: Organization
NPI issued: 20 Nov 2015
Record last updated: 20 Nov 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.