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SRC PROVIDENCE, LLC
NPI 1447615034
Assisted Living Facility in Providence, RI

Active since December 23, 2015
353 BLACKSTONE BLVD, PROVIDENCE, RI 02906(401) 273-6565 Get Directions Write a Review

NPPES record last updated: December 28, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Dec 28, 2015, Dec 23, 2015 (2 updates tracked since 2015).

About Src Providence, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SRC PROVIDENCE, LLC (NPI 1447615034) is a healthcare organization registered as an assisted living facility in Providence, Rhode Island and active in the NPI registry since December 2015. The organization lists Tamilyn Levin, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1447615034
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSRC PROVIDENCE, LLC
Location Address353 BLACKSTONE BLVDProvidence, RI 02906-4936
Mailing Address63 Kendrick StNeedham, MA 02494-2708
Phone(401) 273-6565
Organization SubpartNo
Authorized OfficialTamilyn LevinChief Financial Officer · (781) 707-9510
Enumeration DateDecember 23, 2015
Last NPPES UpdateDecember 28, 20152 updates tracked since enumeration
✔ NPI 1447615034 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

353 BLACKSTONE BLVD, Providence, RI 02906
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Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EPOCH SL I INC
Skilled Nursing Facility
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
MR. EDWARD RYAN HICKEY P.TX
Physical Therapist (Geriatrics)
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 751-6900
EPOCH ON BLACKSTONE BOULEVARD, LLC
Skilled Nursing Facility
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
SRC PROVIDENCE, LLC
Skilled Nursing Facility
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
MRS. DANIELLE GISELE COUGHLIN MSPT
Physical Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 528-0319
STEFANIE LUFT MS, CCC-SLP
Speech-Language Pathologist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 253-6565
DEANNA RECUPERO
Physical Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 235-0944
STEPHANIE CRABTREE
Occupational Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Src Providence, LLC's NPI number?

The NPI number for Src Providence, LLC is 1447615034. It was assigned to this organization in the NPPES registry on December 23, 2015.

Where is Src Providence, LLC located?

Src Providence, LLC is located at 353 Blackstone Blvd, Providence, RI 02906. The listed phone number is (401) 273-6565.

What is Src Providence, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Src Providence, LLC was last updated on December 28, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.