Provider Demographics
NPI:1710015870
Name:BLACKSTONE VALLEY ASSISTED LIVING ENTERPRISE INC.
Entity Type:Organization
Organization Name:BLACKSTONE VALLEY ASSISTED LIVING ENTERPRISE INC.
Other - Org Name:BLACKSTONE VALLEY ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN, ADMINITRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONCETTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DICENZO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:401-725-7045
Mailing Address - Street 1:649 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2803
Mailing Address - Country:US
Mailing Address - Phone:401-725-7045
Mailing Address - Fax:401-725-0004
Practice Address - Street 1:649 BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2803
Practice Address - Country:US
Practice Address - Phone:401-725-7045
Practice Address - Fax:401-725-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01421310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBV48550Medicaid