SRC Blackstone Op, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SRC BLACKSTONE OP, LLC

Practice address

353 Blackstone Blvd
Providence, RI 02906-4936

Phone

(401) 273-6565

Fax

(401) 273-6568

NPI assigned

Nov 19, 2019

Organization subpart

No

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

Authorized official

Name

Jonathan Scharf

Title

General Counsel

Phone

(781) 707-9030

Specialties & licenses 1

Addresses

Other names 1

• Wingate Residences on Blackstone Boulevard Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1588200166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O WINGATE HEALTHCARE, INC.",
            "address_2": "63 KENDRICK STREET",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "02494",
            "telephone_number": "781-707-9000",
            "fax_number": "781-281-8827"
        },
        {
            "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",
            "fax_number": "401-273-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRC BLACKSTONE OP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "SCHARF",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "781-707-9030"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wingate Residences on Blackstone Boulevard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan Springer, FNP-C
• Julie Springwater, M.A.
• Philippa Gabrielle Sprinz, MD
• Emily Borman Spurrell, PHD
• Annarose Squillante, LMHC
• SRC East Side, LLC
• SRC Providence, LLC
• SRC Providence, LLC
• Aradhana Srinagesh
• St Joseph Health Services of Rhode Island

• Assisted Living Facility in Providence, RI
• Providers in Providence, RI by specialty
• Assisted Living Facility in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.