Provider Demographics
NPI:1528716362
Name:BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Entity type:Organization
Organization Name:BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-729-0080
Mailing Address - Street 1:39 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4003
Mailing Address - Country:US
Mailing Address - Phone:401-722-0081
Mailing Address - Fax:401-312-0318
Practice Address - Street 1:39 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4003
Practice Address - Country:US
Practice Address - Phone:401-722-0081
Practice Address - Fax:401-312-0318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy