Providence Support Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PROVIDENCE SUPPORT SERVICES

Practice address

3 Ridgewood Dr
Bordentown, NJ 08505-4737

Phone

(732) 322-3924

Fax

(267) 841-7275

NPI assigned

Jan 28, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Henry O Adebayo, N/ANPI 1235678251

Title

President

Phone

(732) 322-3924

Specialties & licenses 4

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Henry Adebayo

  • Case Manager/Care Coordinator
  • Bordentown, NJ
  • NPI 1235678251
  NPD Authorized official

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

{
    "created_epoch": "1738022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1225841968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 RIDGEWOOD DR",
            "city": "BORDENTOWN",
            "state": "NJ",
            "postal_code": "085054737",
            "telephone_number": "732-322-3924",
            "fax_number": "267-841-7275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RIDGEWOOD DR",
            "city": "BORDENTOWN",
            "state": "NJ",
            "postal_code": "085054737",
            "telephone_number": "732-322-3924",
            "fax_number": "267-841-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-28",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A",
        "authorized_official_last_name": "ADEBAYO",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-322-3924",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordyn Pontoriero, APN, FNP-C
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• Joseph Priolo, LCADC
• Natalie Ralph-Nelson, APN
• Melissa Lillian Rasimowicz, REGISTERED DIETITIAN
• Caitlyn Reardon, CCC-SLP
• Rebecca Boncheck VMD PA
• Reconstructive Orthopedics, P.a.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Bordentown, NJ
• Providers in Bordentown, NJ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; 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.