Healthcare Provider Details

I. General information

NPI: 1972634384
Provider Name (Legal Business Name): BLACKSTONE VALLEY COMMUNITY ACTION PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/21/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 GOFF AVE
PAWTUCKET RI
02860-2928
US

IV. Provider business mailing address

32 GOFF AVE
PAWTUCKET RI
02860-2928
US

V. Phone/Fax

Practice location:
  • Phone: 401-723-4520
  • Fax: 401-722-1053
Mailing address:
  • Phone: 401-723-4520
  • Fax: 401-722-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: VINCENT CEGLIE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-723-4520