Providence Community Service LLC
NPI #1053706812 in Chesterfield, Virginia
Provider Information
- NPI Number
- 1053706812
- Entity Type
- Organization
- Organization Name
- Providence Community Service LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Mar 30, 2015
- Last Updated
- Mar 30, 2015
Practice Location
- Address
- 7011 EGAN PL
- City
- Chesterfield
- State
- Virginia
- ZIP Code
- 23832-8310
- Phone
- (804) 674-1044
Authorized Official
- Name
- JOHN THOMAS EDWARDS
- Title
- C.E.O
- Phone
- (804) 674-1044
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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