SRC Providence, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SRC PROVIDENCE, LLC

Practice address

353 Blackstone Blvd
Providence, RI 02906-4936

Phone

(401) 273-6565

NPI assigned

Nov 20, 2015

Organization subpart

No

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

Authorized official

Name

Tamilyn Levin

Title

Chief Financial Officer

Phone

(781) 707-9510

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447977600000",
    "number": "1336513811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 KENDRICK ST",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024942708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064936",
            "telephone_number": "401-273-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC PROVIDENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2015-11-20",
        "status": "A",
        "authorized_official_last_name": "LEVIN",
        "authorized_official_first_name": "TAMILYN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "781-707-9510"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philippa Gabrielle Sprinz, MD
• Emily Borman Spurrell, PHD
• Annarose Squillante, LMHC
• SRC Blackstone Op, LLC
• SRC East Side, LLC
• SRC Providence, LLC
• Aradhana Srinagesh
• St Joseph Health Services of Rhode Island
• Kathleen St Lawrence, RN, BSN
• Breanne Leigh St Martin, FNP-C

• Skilled Nursing Facility in Providence, RI
• Providers in Providence, RI by specialty
• Skilled Nursing Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; 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.