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SRC BLACKSTONE OP, LLC
NPI 1588200166
Assisted Living Facility in Providence, RI

Active since November 19, 2019
353 BLACKSTONE BLVD, PROVIDENCE, RI 02906(401) 273-6565(401) 273-6568 Get Directions Write a Review

NPPES record last updated: November 19, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Src Blackstone Op, Llc NPPES

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

SRC BLACKSTONE OP, LLC (NPI 1588200166), doing business as Wingate Residences On Blackstone Boulevard, is a healthcare organization registered as an assisted living facility in Providence, Rhode Island and active in the NPI registry since November 2019. The organization lists Jonathan Scharf, General Counsel, as its authorized official.

NPPES Registry Identity

NPI1588200166
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSRC BLACKSTONE OP, LLC
Location Address353 BLACKSTONE BLVDProvidence, RI 02906-4936
Mailing AddressC/o Wingate Healthcare, Inc., 63 Kendrick StreetNeedham, MA 02494 · (781) 707-9000 · Fax (781) 281-8827
Phone(401) 273-6565
Fax(401) 273-6568
Organization SubpartNo
Authorized OfficialJonathan ScharfGeneral Counsel · (781) 707-9030
Enumeration DateNovember 19, 2019
✔ NPI 1588200166 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 Names 1

Doing Business AsWingate Residences On Blackstone Boulevard

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.

MS. DIANA NAVARRO OTR/L
Occupational Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
SHANA COLEMAN OTR/L
Occupational Therapist
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
SRC PROVIDENCE, LLC
Skilled Nursing Facility
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
DEANNA RECUPERO
Physical Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 235-0944
SRC PROVIDENCE, LLC
Assisted Living Facility
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
JANELLE LINDSAY SCOTT OTR, MS
Occupational Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 273-6565
MILESTONE REHAB, L.L.C.
Physical Therapist
353 BLACKSTONE BLVD
PROVIDENCE, RI 02906
Providence County (401) 751-6900

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 Blackstone Op, LLC's NPI number?

The NPI number for Src Blackstone Op, LLC is 1588200166. It was assigned to this organization in the NPPES registry on November 19, 2019. The provider is doing business as Wingate Residences on Blackstone Boulevard.

Where is Src Blackstone Op, LLC located?

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

What is Src Blackstone Op, 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 Blackstone Op, LLC was last updated on November 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.