PROVIDENCE CARE INC (NPI# 1376805630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376805630 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE CARE INC |
| Other Organization Name | PROVIDENCE PRIVATE CARE HOME AND PROVIDENCE COMMUNITY LIVING ARRANGEM |
| Practice Address |
216 Nw Broad St Ste B Fairburn GA 30213-4106 |
| Practice Telephone | 6784892069 |
| Practice Fax Number | 6784898627 |
| Mailing Telephone | 6784892069 |
| Mailing Fax Number | 6784898627 |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |
| Authorized Official Name | DR. STELLA NGOZI OKPALA (DIRECTOR/OWNER) |
| Authorized Official Telephone | 4049317854 |
| Authorized Official Credential | PHARM.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 060-R-1019 | GA | Agencies |
| Other Name | Type Code |
|---|---|
| providence private care home and providence community living arrangem | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174026736 | Providence Care Inc | Registered Nurse | 808 Bristol Dr, Smyrna, TN 37167-8329 | 2018-03-09 |
| 1245376375 | Providence Care Inc | Nursing Care | 5711 Sarvis Ave Ste 608, Riverdale, MD 20737-1394 | 2007-01-29 |
| 1467869602 | Providence Care Inc | Skilled Nursing Facility | 835 Herkimer St, Brooklyn, NY 11233-3031 | 2014-07-21 |
| 1477860112 | Providence Care Inc | Internal Medicine | 8929 Parallel Pkwy, Kansas City, KS 66112-1689 | 2010-09-01 |
| 1962684241 | Providence Care Inc | Pharmacy | 6434 Saratoga Blvd, Ste A, Corpus Christi, TX 78414-3425 | 2007-11-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | PROVIDENCE CARE INC. | 5711 Sarvis Avenue, Suite 608, Riverdale, Maryland 20737 |
| Street Address |
216 NW BROAD ST STE B |
| City | FAIRBURN |
| State | GA |
| Zip Code | 30213-4106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578889119 | Stella Ngozi Okpala | Pharmacist | 216 Nw Broad St Ste B, Fairburn, GA 30213-4106 | 2010-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457984262 | Stephanie Westbrook | Counselor | 5847 Landers Loop, Fairburn, GA 30213 | 2020-02-20 |
| 1255990529 | Compass Home Dialysis LLC | Clinic/Center | 178 West Cambellton St, Fairburn, GA 30213 | 2019-06-11 |
| 1780152694 | Selah | In Home Supportive Care | 5228 Rosewood Place, Fairburn, GA 30213 | 2018-11-08 |
| 1134642846 | Shaquina Jimmerson | Counselor | 1401 Peachtree St Ne, Suite 500, Atlanta, GA 30213 | 2017-07-25 |
| 1013447143 | Destoni Fleming | Durable Medical Equipment & Medical Supplies | 3885 Grassy Trace, Fairburn, GA 30213 | 2017-06-12 |
| 1003290891 | Tanya Sykes-clark | Speech-Language Pathologist | 6179 Chastain Way, Fairburn, GA 30213 | 2015-07-13 |
| 1467858613 | Dayo Ahisha Williams | Licensed Practical Nurse | 8064 South Fulton Parkway #1102, Fairburn, GA 30213 | 2014-11-17 |
| 1144658543 | Vanetta Donna Della Williams | Social Worker | 7923 Heathmore Drive, Fairburn, GA 30213 | 2013-10-22 |
| 1831522671 | Monique Harris | Social Worker | 7922 Applemist Dr, Fairburn, GA 30213 | 2013-08-15 |
| 1255668406 | Linda Walton | Occupational Therapy Assistant | 7040 Smoke Ridge Dr, Fairburn, GA 30213 | 2009-11-09 |
| Find all providers in zip 30213 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265972632 | Breezy Houston | Community/Behavioral Health | 4680 Sundridge Trl, Fairburn, GA 30213-1997 | 2017-03-03 |
| 1932651072 | Unique Destiny Inc | Community/Behavioral Health | 7117 Walton Hl, Fairburn, GA 30213-7112 | 2016-10-25 |
| 1669800793 | Brooker Richardson and Associates | Community/Behavioral Health | 460 Berkshire Pl, Fairburn, GA 30213-2069 | 2013-10-29 |
| 1982913133 | Bella Gardens Senior Living | Community/Behavioral Health | 8461 Cedar Grove Rd, Fairburn, GA 30213-2338 | 2010-10-05 |
| 1366750507 | Helping Educate and Train Inc. | Community/Behavioral Health | 7645 Bowhead Ct, Fairburn, GA 30213-3278 | 2010-09-22 |
| 1104081173 | A-positive Intervention Corporated | Community/Behavioral Health | 823 Covered Bridge Way, Fairburn, GA 30213-9611 | 2008-07-18 |
| 1699104281 | A Brighter Day | Community/Behavioral Health | 460 Berkshire Pl, Fairburn, GA 30213-2069 | 2013-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376160 | Love, Breanna Olivia Zion Enterprise,llc(lboz): | Community/Behavioral Health | 9802 N Ivy Park Dr, Fortson, GA 31808-7130 | 2020-11-02 |
| 1578170882 | Helping Hearts Behavioral Health Services, LLC | Community/Behavioral Health | 504 Hamlet Dr, Hampton, GA 30228-4829 | 2020-09-30 |
| 1982219523 | Future Seekers, Inc. | Community/Behavioral Health | 3475 N. Desert Drive, Building 1, Suite 2100, East Point, GA 30344-3034 | 2020-09-10 |
| 1396359840 | Just Like Family Caregivers | Community/Behavioral Health | 2628 Lovejoy Crossing St, Hampton, GA 30228-5995 | 2020-09-02 |
| 1285247270 | Hudu Yoga & Therapy | Community/Behavioral Health | 3900 Springleaf Ct, Stone Mountain, GA 30083-4692 | 2020-08-28 |
| 1952914632 | Brighter Dayz, Incorporated | Community/Behavioral Health | 1016 Howell Mill Rd Nw Apt 4408, Atlanta, GA 30318-5592 | 2020-08-24 |
| 1699387688 | Rise Rehabilitation Services, LLC | Community/Behavioral Health | 738 Highland Park Trl, Atlanta, GA 30350-6706 | 2020-08-20 |
| 1104438373 | Pivotal Counseling LLC | Community/Behavioral Health | 75 N Broad St, Winder, GA 30680-1907 | 2020-08-19 |
| 1295347888 | Freemans Early Intervention Services | Community/Behavioral Health | 13 Peach St, Butler, GA 31006 | 2020-08-17 |
| 1861017634 | Trinity Care Counseling | Community/Behavioral Health | 3475 Northwinds Parkway, 200, Alpharetta, GA 30009 | 2020-06-08 |
| Find all providers with the same taxonomy | ||||
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| 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.