SRC PROVIDENCE, LLC (NPI# 1447615034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447615034 |
| Entity Type | Organization |
| Organization Name | SRC PROVIDENCE, LLC |
| Practice Address |
353 Blackstone Blvd Providence RI 02906-4936 |
| Mailing Address |
63 Kendrick St Needham MA 02494-2708 |
| Practice Telephone | 4012736565 |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2015-12-28 |
| Authorized Official Name | TAMILYN LEVIN (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7817079510 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336513811 | Src Providence, LLC | Skilled Nursing Facility | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2015-11-20 |
| Street Address |
353 BLACKSTONE BLVD |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02906-4936 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548230097 | Milestone Rehab, L.L.C. | Physical Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2006-01-26 |
| 1588200166 | Src Blackstone Op, LLC | Assisted Living Facility | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2019-11-19 |
| 1245688332 | Shana Coleman | Occupational Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2016-05-30 |
| 1982052163 | Stephanie Crabtree | Occupational Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2016-05-29 |
| 1427406677 | Deanna Recupero | Physical Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2016-05-27 |
| 1275981714 | Danielle Gisele Coughlin | Physical Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2016-05-25 |
| 1609224187 | Stefanie Luft | Speech-Language Pathologist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2016-05-25 |
| 1336513811 | Src Providence, LLC | Skilled Nursing Facility | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2015-11-20 |
| 1720268402 | Epoch On Blackstone Boulevard, LLC | Skilled Nursing Facility | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2007-11-09 |
| 1992867485 | Edward Ryan Hickey | Physical Therapist | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2006-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285245175 | Birdsong Traditional Medicine, LLC | Acupuncturist | 148 Waterman St. Ground Level, Providence, RI 02906 | 2020-08-13 |
| 1881218071 | Madison Pomerantz | Psychiatry & Neurology | 345 Blackstone Boulevard, Box G-bh, Providence, RI 02906 | 2020-06-03 |
| 1316453855 | Ellen Van Ingen Darling | Psychologist | 285 Governor St Ste 250, Providence, RI 02906 | 2017-12-20 |
| 1275063919 | Marissa Martz | Psychiatry & Neurology | 345 Blackstone Blvd., Providence, RI 02906 | 2017-06-15 |
| 1235663220 | Alena Haltzman | Counselor | 223 Summit Ave, Providence, RI 02906 | 2017-04-17 |
| 1669823399 | Kathryn Fleming-ives LLC | Psychiatry & Neurology | 355 Hope St Unit 1, Providence, RI 02906 | 2016-06-23 |
| 1134573389 | Sarah E. Kramer | Psychiatry & Neurology | Butler Hospital, Adult Psychiatry Residency, 345 Blackstone Blvd, Providence, RI 02906 | 2016-04-13 |
| 1538534201 | Laura Anne Buss | Social Worker | 55 Hope St., Providence, RI 02906 | 2015-12-07 |
| 1700289360 | Tinatin Surguladze | Counselor | 205 Waterman St Suite 106, Providence, RI 02906 | 2014-09-26 |
| 1467851519 | Jamila Allouane | Social Worker | 120 Wayland Avenue Suite 2, Providence, RI 02906 | 2014-08-14 |
| Find all providers in zip 02906 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922403062 | Highland East LLC | Assisted Living Facility | 101 Highland Ave, Providence, RI 02906-2748 | 2014-10-31 |
| 1083835300 | St. Joseph Living Center | Assisted Living Facility | 153 Dean St, Providence, RI 02903-1603 | 2007-05-02 |
| 1629123021 | Saint Elizabeth Assisted Living, L.p. | Assisted Living Facility | 109 Melrose St, Providence, RI 02907-1856 | 2007-01-24 |
| 1588200166 | Src Blackstone Op, LLC | Assisted Living Facility | 353 Blackstone Blvd, Providence, RI 02906-4936 | 2019-11-19 |
| 1700429545 | Ginger Care, Inc. | Assisted Living Facility | 1 Butler Ave, Providence, RI 02906-5119 | 2019-10-24 |
| 1912567744 | Kre Husky Providence Licensee LLC | Assisted Living Facility | 700 Smith St, Providence, RI 02908-3500 | 2019-06-14 |
| 1952814311 | Charlesgate Senior Living Center | Assisted Living Facility | 670 N Main St, Providence, RI 02904 | 2017-11-08 |
| 1427422906 | Src East Side, LLC | Assisted Living Facility | 1 Butler Ave, Providence, RI 02906-5119 | 2015-11-20 |
| 1346519733 | Arbor Hill | Assisted Living Facility | 153 Dean St, Providence, RI 02903-1603 | 2011-12-14 |
| 1144549122 | Cache Valley Assisted Living | Assisted Living Facility | 233 N Main St, Providence, UT 84332-9622 | 2010-05-29 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02906 |
Please comment or provide details below to improve the information on SRC PROVIDENCE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.