Src Providence, LLC
NPI #1447615034 in Providence, Rhode Island
Provider Information
- NPI Number
- 1447615034
- Entity Type
- Organization
- Organization Name
- Src Providence, LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Dec 23, 2015
- Last Updated
- Dec 28, 2015
Practice Location
- Address
- 353 BLACKSTONE BLVD
- City
- Providence
- State
- Rhode Island
- ZIP Code
- 02906-4936
- Phone
- (401) 273-6565
Authorized Official
- Name
- TAMILYN LEVIN
- Title
- CHIEF FINANCIAL OFFICER
- Phone
- (781) 707-9510
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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