Children's Shelter of Blackstone Valley, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

40 Issued in RI

Legal business name

CHILDREN'S SHELTER OF BLACKSTONE VALLEY, INC.

Practice address

15 Gates St
Pawtucket, RI 02861-3225

Phone

(401) 722-4626

Fax

(401) 727-2967

NPI assigned

Mar 16, 2007

Last updated

Sep 28, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Eileen F Hernandez, MS

Title

Executive Director

Phone

(401) 722-4626

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1124152392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GATES STREET",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "02861",
            "telephone_number": "401-722-4626",
            "fax_number": "401-727-2967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GATES ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028613225",
            "telephone_number": "401-722-4626",
            "fax_number": "401-727-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SHELTER OF BLACKSTONE VALLEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "401-722-4626",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "RI",
            "license": "40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Charron
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• Russell Soy Chin, DDS
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• Jonathan Chisholm, MA, LMHC
• Joyce Chisholm, RN
• Seungyeon Choi

• Emotionally Disturbed Childrens' Residential Treatment Facility in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.