Organization
SRC BLACKSTONE OP, LLC
Active
Other names
Wingate Residences on Blackstone Boulevard
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SCHARF (GENERAL COUNSEL)
(781) 707-9030
Entity
Organization
Contact information
Practice address
353 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4936
(401) 273-6565
(401) 273-6568
Mailing address
C/O WINGATE HEALTHCARE, INC., 63 KENDRICK STREET, NEEDHAM, MA 02494
(781) 707-9000
(781) 281-8827
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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