Provider Demographics
NPI:1992910004
Name:B-X PROVIDENCE LLC
Entity type:Organization
Organization Name:B-X PROVIDENCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-489-7100
Mailing Address - Street 1:40 WILLIAM ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3999
Mailing Address - Country:US
Mailing Address - Phone:781-489-7100
Mailing Address - Fax:
Practice Address - Street 1:700 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3500
Practice Address - Country:US
Practice Address - Phone:401-521-0090
Practice Address - Fax:401-453-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility