NPI 1588200166

Src Blackstone Op, LLC

Organisation Assisted Living Facility Providence, RI

Practice location

Address: 353 Blackstone Blvd, Providence, RI 02906-4936
Phone: (401) 273-6565
Fax: (401) 273-6568
Mailing address: C/O Wingate Healthcare, INC. 63 Kendrick Street, Needham, MA 02494

Authorised official

Name: Jonathan Scharf
Title: General Counsel
Phone: (781) 707-9030

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

Other Assisted Living Facility providers in Rhode Island →

Registry record

NPI: 1588200166
Entity type: Organization
NPI issued: 19 Nov 2019
Record last updated: 19 Nov 2019

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.