PROVIDENCE COMMUNITY SERVICE LLC
NPI 1053706812
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Chesterfield, VA
- Organization
- Community Based Residential Treatment Fa...
About PROVIDENCE COMMUNITY SERVICE LLC
This page provides the complete NPI Profile along with additional information for Providence Community Service Llc, a provider established in Chesterfield, Virginia operating as a Community Based Residential Treatment Facility, Intellectual And/or Developmental Disabilities. The healthcare provider is registered in the NPI registry with number 1053706812 assigned on March 2015. The practitioner's primary taxonomy code is 320900000X with license number 225301001 (VA). The provider is registered as an organization and their NPI record was last updated 11 years ago. The authorized official of this NPI record is John Thomas Edwards (C.e.o)
- NPI
- 1053706812 Verify this NPI
- Provider Name
- PROVIDENCE COMMUNITY SERVICE LLC
- Entity Type
- Organization
- Location Address
- 7011 EGAN PL CHESTERFIELD, VA 23832
- Location Phone
- (804) 674-1044
- Location Fax
- (804) 674-1110
- Mailing Address
- 7011 EGAN PL CHESTERFIELD, VA 23832
- Mailing Phone
- (804) 674-1044
- Mailing Fax
- (804) 674-1110
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-30-2015
- Last Update Date
- 03-30-2015
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Taxonomy Code
- 320900000X
- Type
- Residential Treatment Facilities
- License No.
- 225301001
- License State
- VA
- Taxonomy Description
- A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1053706812, enumerated as an "organization" on March 30, 2015.
The provider is located at 7011 EGAN PL CHESTERFIELD, VA 23832 and the phone number is (804) 674-1044.
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.
