Provider Demographics
NPI:1417224767
Name:BLACKSTONE REHABILITATION HOSPITAL, INC.
Entity Type:Organization
Organization Name:BLACKSTONE REHABILITATION HOSPITAL, INC.
Other - Org Name:NORTHERN RI REHAB MANAGEMENT ASSOCIATES, LP - INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-419-4772
Mailing Address - Street 1:196 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4712
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:401-765-6024
Practice Address - Street 1:116 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7327
Practice Address - Country:US
Practice Address - Phone:401-766-0800
Practice Address - Fax:401-762-3112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWARD MEDICAL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRHC02102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413025Medicare Oscar/Certification