NPIMap

Organization Active NPI

SRC Providence, LLC

  • Assisted Living Facility
  • Providence, RI
National Provider Identifier
1447615034
Registry record updated Dec 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
SRC PROVIDENCE, LLC
Practice address
353 Blackstone Blvd
Providence, RI 02906-4936
Phone
(401) 273-6565
NPI assigned
Dec 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2015

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

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

353 Blackstone Blvd
Providence, RI 02906-4936

Mailing address

63 Kendrick St
Needham, MA 02494-2708

National Provider Directory

National Provider Directory
Tax ID family
Epoch on Blackstone Boulevard LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1450828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1447615034",
    "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": "2015-12-23",
        "last_updated": "2015-12-28",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.