Providential Facility Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

PROVIDENTIAL FACILITY SERVICES, LLC

Practice address

611 Ford St
Greenville, NC 27834-2935

Phone

(252) 902-2617

NPI assigned

Apr 11, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Coy Randolpf Jr.

Title

Owner

Phone

(252) 902-2617

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1144510157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 GLENVIEW DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 FORD ST",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342935",
            "telephone_number": "252-902-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENTIAL FACILITY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "RANDOLPF",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "COY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-902-2617",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elena Mary Propst, MMS, MBA, PA-C
• Prosource Therapeutics LLC
• Anthony Provenzano
• Casaundra Camille Provenzano, MD
• Providential Care: Center for Mental Wellness, PLLC
• Proximity Management and Staffing Services, LLC
• Proximity Management and Staffing Services, LLC
• Pruitthealth Hospice, Inc. (PruittHealth Hospice - Eastern Carolina)
• Lisa Dawn Prusinski, D.C.
• Barbara Leary Pryor, OT

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Greenville, NC
• Providers in Greenville, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.