Healthcare Provider Details

I. General information

NPI: 1740315829
Provider Name (Legal Business Name): ARC OF BLACKTONE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PAWTUCKET AVE
EAST PROVIDENCE RI
02914-1611
US

IV. Provider business mailing address

115 MANTON ST
PAWTUCKET RI
02861-4332
US

V. Phone/Fax

Practice location:
  • Phone: 401-727-0150
  • Fax:
Mailing address:
  • Phone: 401-727-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number102
License Number StateRI

VIII. Authorized Official

Name: KATHERINE S HUNT
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 401-727-0150