PROVIDENCE COMMUNITY SERVICE LLC


Address: 7011 Egan Pl, Chesterfield, VA 23832-8310
Phone: 8046741044

PROVIDENCE COMMUNITY SERVICE LLC (NPI# 1053706812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053706812
Entity Type Organization
Organization Name PROVIDENCE COMMUNITY SERVICE LLC
Practice Address 7011 Egan Pl
Chesterfield
VA 23832-8310
Practice Telephone 8046741044
Practice Fax Number 8046741110
Mailing Telephone 8046741044
Mailing Fax Number 8046741110
Enumeration Date 2015-03-30
Last Update Date 2015-03-30
Authorized Official Name JOHN THOMAS EDWARDS (C.E.O)
Authorized Official Telephone 8046741044
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 225301001 VA Residential Treatment Facilities

Office Location

Street Address 7011 EGAN PL
City CHESTERFIELD
State VA
Zip Code 23832-8310

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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
Notes: [7/1/2003: new]

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NPI Name Taxonomy Address Enumeration
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Competitor

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City CHESTERFIELD
Zip Code 23832

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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