Organization
BLACKSTONE MEDICAL CENTER, INC.
Active
Organization
BLACKSTONE MEDICAL CENTER, INC.
Active
Parent organization
STEWARD MEDICAL HOLDINGS, LLC
Other names
Blackstone Medical Center Psych
Organization subpart
Yes
Provider details
NPI number
Legal business name
STEWARD MEDICAL HOLDINGS, LLC
Authorized official
MR. JAMES RENNA (CFO)
(617) 419-4772
Entity
Organization
Contact information
Practice address
115 CASS AVE, WOONSOCKET, RI 02895-4705
(401) 769-4100
Mailing address
219 CASS AVENUE, WOONSOCKET, RI 02895-4741
(401) 769-4100
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
00117
RI
103TP0016X
Prescribing (Medical) Psychologist
00117
RI
207R00000X
Internal Medicine Physician
Primary
00117
RI
2084N0400X
Neurology Physician
00117
RI
2084P0800X
Psychiatry Physician
00117
RI
363L00000X
Nurse Practitioner
00117
RI
Other
Enumeration date
07/13/2012
Last updated
07/30/2012
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