NPIMap

Organization Active NPI

Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pawtucket, RI
National Provider Identifier
1063574135
Registry record updated Mar 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
ACF01536 Issued in RI
Legal business name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Practice address
39 East Ave
Pawtucket, RI 02860-4003
Phone
(401) 312-9892
NPI assigned
Dec 15, 2006
Last updated
Mar 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cristina Pacheco, MDNPI 1386757656
Title
Ceo
Phone
(401) 312-9892

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X ACF01536 RI Primary
Community Health Worker 172V00000X
Community/Behavioral Health Agency 251S00000X ACF01536 RI

Addresses

Primary practice location

39 East Ave
Pawtucket, RI 02860-4003

Mailing address

39 East Ave
Pawtucket, RI 02860-4003
Phone (401) 312-9892

Other practice location 1

1000 Broad St
Central Falls, RI 02863-1507
Phone (401) 722-0081

Other practice location 2

42 Park Pl
Pawtucket, RI 02860-4010
Phone (401) 722-0081

Other practice location 3

1145 Main St
Pawtucket, RI 02860-7825
Phone (401) 722-0081

Other practice location 4

10 Higginson Ave
Central Falls, RI 02863
Phone (401) 722-0081

Other identifiers 1

IdentifierTypeStateIssuer
BV01759MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040916000775 RI Part B Supplier - Clinic/Group Practice 8628045762 Receives reassigned benefits from 82 practitioners
1 other NPI on this enrollment
Practice locations: Central Falls, RI; Pawtucket, RI
O20101102001316 RI Part A Provider - Federally Qualified Health Center (FQHC) 8628045762 Practice locations: Pawtucket, RI
O20160208001907 RI Part A Provider - Federally Qualified Health Center (FQHC) 8628045762 Practice locations: Pawtucket, RI
O20160718001565 RI Part A Provider - Federally Qualified Health Center (FQHC) 8628045762 Practice locations: Pawtucket, RI
O20160725001617 RI Part A Provider - Federally Qualified Health Center (FQHC) 8628045762 Practice locations: Central Falls, RI

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1063574135. Details of each certification follow.

Federally qualified health center certification: CCN 411807

Legal name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 11, 1976 in RI
Enrollment address
39 East Ave
Pawtucket, RI 28604010

Federally qualified health center certification: CCN 411851

Legal name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2016
Last certification
Mar 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1976 in RI
Enrollment address
1145 Main St
Pawtucket, RI 28604807

Federally qualified health center certification: CCN 411853

Legal name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2016
Last certification
Aug 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 2011 in RI
Enrollment address
42 Park PL
Pawtucket, RI 28604010

Federally qualified health center certification: CCN 411852

Legal name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2016
Last certification
Aug 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1976 in RI
Enrollment address
1000 Broad St
Central Falls, RI 28631507

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D2163839Blackstone Valley Community Health Care, Inc1000 Broad St, Central Falls, RI 02863Certificate of waiverMar 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Blackstone Valley Community Health Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10 Higginson Ave
Central Falls, RI 02863
Phone (401) 722-0081

24 Summer St
Central Falls, RI 02863

9 Chestnut St
Central Falls, RI 02863
Phone (401) 722-0081

210 Main St
Pawtucket, RI 02860
Phone (401) 312-9892

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel Correia Individual Corporate DirectorBoard Member Jan 1, 2021
Blackstone Valley Community Health Care Inc Organization, Pawtucket, RI 5% Or Greater Direct Ownership Interest Nov 28, 2012 100%
Cristina Pacheco Individual Corporate DirectorCeo May 20, 2024 100%
W-2 Managing EmployeeCeo May 20, 2024 100%
W-2 Managing Employee May 20, 2024 100%
David Ragosta Individual Corporate OfficerCfo Jan 31, 2022
W-2 Managing EmployeeCfo Jan 31, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 112

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 112

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1063574135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 EAST AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604003",
            "telephone_number": "401-312-9892",
            "fax_number": "401-312-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 EAST AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604003",
            "telephone_number": "401-312-9892"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Broad St",
            "address_purpose": "LOCATION",
            "city": "Central Falls",
            "state": "RI",
            "postal_code": "028631507",
            "country_code": "US",
            "telephone_number": "401-722-0081",
            "fax_number": "401-722-0081",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42 Park Pl",
            "address_purpose": "LOCATION",
            "city": "Pawtucket",
            "state": "RI",
            "postal_code": "028604010",
            "country_code": "US",
            "telephone_number": "401-722-0081",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1145 Main St",
            "address_purpose": "LOCATION",
            "city": "Pawtucket",
            "state": "RI",
            "postal_code": "028607825",
            "country_code": "US",
            "telephone_number": "401-722-0081",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Higginson Ave",
            "address_purpose": "LOCATION",
            "city": "Central Falls",
            "state": "RI",
            "postal_code": "02863",
            "country_code": "US",
            "telephone_number": "401-722-0081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "401-312-9892",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "RI",
            "license": "ACF01536",
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "RI",
            "license": "ACF01536",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BV01759",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.