PROVIDENCE PLACE INC NPI 1801064118

NPI Information

NPI: 1801064118
Provider Name: PROVIDENCE PLACE, INC

Former Legal Business Name: PROVIDENCE PLACE FAMILY CARE HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
916 CLAYTON RD
DURHAM, NC
ZIP 27703
Phone: (919) 767-9037
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PROVIDENCE PLACE, INC is an intermediate care facility mentally retarded in Durham, NC. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PROVIDENCE PLACE, INC NPI is 1801064118. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Providence Place Family Care Home.

The provider's business location address is:

916 CLAYTON RD
DURHAM, NC
ZIP 27703-608
Phone: (919) 767-9037
Fax: (919) 767-9037

The provider's authorized official is Moses Oladapo Olanrewaju .
The authorized official title is Ceo/administrator and has the following contact phone number (919) 767-9037.

The enumeration date for this NPI number is 2/20/2008 and was last updated on 2/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		MHL-032-422	NORTH CAROLINA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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