Provider Demographics
NPI:1275663379
Name:BLACKSTONE VALLEY COMMUNITY ACTION PROGRAM, INC.
Entity Type:Organization
Organization Name:BLACKSTONE VALLEY COMMUNITY ACTION PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CEGLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-723-4520
Mailing Address - Street 1:32 GOFF AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2928
Mailing Address - Country:US
Mailing Address - Phone:401-723-4520
Mailing Address - Fax:401-722-1053
Practice Address - Street 1:32 GOFF AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2928
Practice Address - Country:US
Practice Address - Phone:401-723-4520
Practice Address - Fax:401-722-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBV07671Medicaid