Provider Demographics
NPI:1396860730
Name:THE ARC OF BLACKSTONE VALLEY
Entity Type:Organization
Organization Name:THE ARC OF BLACKSTONE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-727-0150
Mailing Address - Street 1:115 MANTON ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4332
Mailing Address - Country:US
Mailing Address - Phone:401-727-0150
Mailing Address - Fax:401-727-1545
Practice Address - Street 1:305 OWEN AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1521
Practice Address - Country:US
Practice Address - Phone:401-727-0150
Practice Address - Fax:401-727-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI78315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOA02821Medicare ID - Type UnspecifiedWAIVER GROUP HOME