Healthcare Provider Details

I. General information

NPI: 1356157770
Provider Name (Legal Business Name): CHARTERCARE BLACKSTONE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE STE 300
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

1526 ATWOOD AVE STE 300
JOHNSTON RI
02919-3289
US

V. Phone/Fax

Practice location:
  • Phone: 401-459-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ELDERS
Title or Position: SECRETARY
Credential:
Phone: 310-943-4500