PROVIDENCE COMMUNITY SERVICES (NPI# 1578743357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578743357 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE COMMUNITY SERVICES |
| Practice Address |
3635 Ruffin Rd Ste 100 San Diego CA 92123-1853 |
| Practice Telephone | 8583000460 |
| Practice Fax Number | 8583000461 |
| Mailing Telephone | 8583000460 |
| Mailing Fax Number | 8583000461 |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2007-11-08 |
| Authorized Official Name | MR. GREGORY THOMAS (INTERN MARRIAGE FAMILY) |
| Authorized Official Telephone | 8583000460 |
| Authorized Official Credential | M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | IMF 53380 | CA | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871973073 | Providence Community Services | Community/Behavioral Health | 41 Crystal St, Apt 4, East Stroudsburg, PA 18301-2874 | 2015-06-02 |
| 1386063055 | Providence Community Services | Counselor | 2425 Olympic Blvd, Suite #4000-w, Santa Monica, CA 90404-4030 | 2014-04-10 |
| 1699194209 | Providence Community Services | Counselor | 2600 Michelson Dr, Suite #1700, Irvine, CA 92612-1550 | 2014-04-10 |
| 1124447750 | Providence Community Services | Counselor | 1140 W. Bernardo Court, Suite #300, San Diego, CA 92127 | 2014-04-10 |
| 1205255825 | Providence Community Services | Counselor | 500 N State College Blvd, Suite #1100, Orange, CA 92868-1604 | 2014-04-10 |
| 1063831931 | Providence Community Services | Counselor | 21550 Oxnard St, 3rd Floor, Woodland Hills, CA 91367-7100 | 2014-04-08 |
| 1245659135 | Providence Community Services | Counselor | 16755 Von Karman Ave, Suite #300, Irvine, CA 92606-4930 | 2014-04-08 |
| 1053730945 | Providence Community Services | Counselor | 18101 Von Karman Ave, 3rd Floor, Irvine, CA 92612-1012 | 2014-04-08 |
| 1710306600 | Providence Community Services | Counselor | 26632 Towne Centre Dr, Suite #300, Foothill Ranch, CA 92610-2813 | 2014-04-08 |
| 1255754784 | Providence Community Services | Social Worker | 3890 11th. Street, Suite 118, Riverside, CA 92501 | 2014-02-04 |
| Street Address |
3635 RUFFIN RD STE 100 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92123-1853 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639378060 | Ruben Vega | Counselor | 3635 Ruffin Rd Ste 100, San Diego, CA 92123-1853 | 2007-07-16 |
| 1609058619 | Gregory Thomas | Counselor | 3635 Ruffin Rd Ste 100, San Diego, CA 92123-1853 | 2007-11-30 |
| 1699957852 | Alex Negrin | Case Manager/Care Coordinator | 3635 Ruffin Rd Ste 100, San Diego, CA 92123-1853 | 2007-11-29 |
| 1437338621 | Providence Community Services | Point of Service | 3635 Ruffin Rd Ste 100, San Diego, CA 92123-1853 | 2007-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087326 | Corina Lozano Manzo | Registered Nurse | 7436 Mission Center Road, San Diego, CA 92123 | 2020-09-10 |
| 1831703537 | Shannon Leigh Doolittle | Audiologist | 3020 Children's Way Mc5010, San Diego, CA 92123 | 2020-09-01 |
| 1861014359 | Ha Thanh Truong | Pharmacist | Rezcare, 3821 Calle Fortunada, San Diego, CA 92123 | 2020-05-07 |
| 1023667136 | Brittany Meyer | Physical Therapist | 3020 Children's Waymc5068, San Diego, CA 92123 | 2019-09-11 |
| 1598313272 | Ryan Edward Shaw | Marriage & Family Therapist | 8910 Clairmont Mesa Blvd, San Diego, CA 92123 | 2019-08-27 |
| 1528611910 | Tanisha C Fulcher | Marriage & Family Therapist | 8825 Aero Dr., Ste 315, San Diago, CA 92123 | 2019-07-24 |
| 1245795665 | Robin James Pekin | Marriage & Family Therapist | 4450 Kearny Villa Rd, #116, San Diego, CA 92123 | 2019-02-11 |
| 1174093728 | Karen Vences | Counselor | 8755 Aero Dr Suite 230, San Diego, CA 92123 | 2018-11-27 |
| 1255808465 | Natasha Herrera | Counselor | 2801 Meadow Lark Dr, San Diego, San Diego, CA 92123 | 2018-10-25 |
| 1407321987 | Maneka Elikewela | Behavior Technician | 3934 Murphy Canyon Rd, Ste B202, San Diego, CA 92123 | 2018-10-10 |
| Find all providers in zip 92123 | ||||
| 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 |
|---|---|---|---|---|
| 1134729718 | Cynthia Felicia Delaney | Community/Behavioral Health | 4887 Bella Pacific Row Unit 240, San Diego, CA 92109-8515 | 2020-10-31 |
| 1790390359 | Institute of Behavioral Sciences and Technology Family Counseling | Community/Behavioral Health | 9655 Granite Ridge Dr Ste Ofc2005, San Diego, CA 92123-2674 | 2020-09-10 |
| 1902426018 | Clayton Counseling Licensed Clinical Social Worker Inc. | Community/Behavioral Health | 2180 Garnet Ave Ste 2e, San Diego, CA 92109-3675 | 2020-04-17 |
| 1679113765 | Kristina Copley Marriage and Family Therapy, Inc | Community/Behavioral Health | 1267 Rosecrans St Ste B, San Diego, CA 92106-2692 | 2020-01-07 |
| 1417598319 | Open Heart Leaders | Community/Behavioral Health | 1913 Euclid Ave Ste 108, San Diego, CA 92105-5360 | 2019-10-01 |
| 1710531405 | Katherine Raftery | Community/Behavioral Health | 3570 Granada Ave, San Diego, CA 92104-4145 | 2019-07-31 |
| 1063064509 | Abigail Frances Swan | Community/Behavioral Health | 3376 Grim Ave Apt 3, San Diego, CA 92104-4650 | 2019-07-15 |
| 1548726862 | Unscripted Learning | Community/Behavioral Health | 3717 India St, San Diego, CA 92103-3727 | 2019-02-11 |
| 1356806509 | Vista Hill Foundation | Community/Behavioral Health | 8825 Aero Drive, Suite 315, San Diego, CA 92123-1104 | 2019-02-01 |
| 1891275707 | Kelley Kozlowski | Community/Behavioral Health | 4804 Iroquois Ave, San Diego, CA 92117-6248 | 2018-08-20 |
| Find all providers in SAN DIEGO | ||||
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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.