41D0082689 CLIA NUMBER - BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC

Laboratory Demographics

CLIA Number: 41D0082689

Facility Name: BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC

Facility Address:
39 EAST AVE
PAWTUCKET, RI
ZIP 02860
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Facility Phone Number: 401 729-0081

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1942473103

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	41D0082689
LAB Type	Federally Qualified Health Center
Facility Name	BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Street	39 EAST AVE
City	PAWTUCKET
State	RI
ZIP	02860
Phone	401 729-0081
CertificateType	4
CertificateEffectiveDate	6/3/2022
CertificateExpirationDate	6/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024