Provider Demographics
NPI:1295919900
Name:BLACKSTONE VALLEY YOUTH & FAMILY COLLABORATIVE
Entity type:Organization
Organization Name:BLACKSTONE VALLEY YOUTH & FAMILY COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-475-2121
Mailing Address - Street 1:209 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3026
Mailing Address - Country:US
Mailing Address - Phone:401-475-2121
Mailing Address - Fax:401-475-2255
Practice Address - Street 1:209 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3026
Practice Address - Country:US
Practice Address - Phone:401-475-2121
Practice Address - Fax:401-475-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI251FC00000XMedicaid