Healthcare Provider Details

I. General information

NPI: 1063574135
Provider Name (Legal Business Name): BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 EAST AVE
PAWTUCKET RI
02860-4003
US

IV. Provider business mailing address

39 EAST AVE
PAWTUCKET RI
02860-4003
US

V. Phone/Fax

Practice location:
  • Phone: 401-312-9892
  • Fax:
Mailing address:
  • Phone: 401-312-9892
  • Fax: 401-312-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberACF01536
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberACF01536
License Number StateRI

VIII. Authorized Official

Name: CRISTINA PACHECO
Title or Position: CEO
Credential: MD
Phone: 401-312-9892