NPIMap

Organization Active NPI

Providence Care Inc

  • Developmental Disabilities Clinic/Center
  • Riverdale, MD
National Provider Identifier
1245376375
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
PROVIDENCE CARE INC
Practice address
5711 Sarvis Ave Ste 608
Riverdale, MD 20737-1394
Phone
(301) 277-4337
NPI assigned
Jan 29, 2007
Last updated
Nov 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Authorized official

Name
Guillaume Sery Kabert
Title
Owner/Ceo
Phone
(301) 277-4337

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X NU
Developmental Disabilities Clinic/Center 261QD1600X NU Primary
In Home Supportive Care Agency 253Z00000X 039714600 DC

Addresses

Primary practice location

5711 Sarvis Ave Ste 608
Riverdale, MD 20737-1394

Mailing address

5711 Sarvis Ave Ste 608
Riverdale, MD 20737-1394
Phone (301) 277-4337

Other practice location 1

6911 Richmond Hwy Ste 266
Alexandria, VA 22306-1844
Phone (703) 718-0931

Other identifiers 2

IdentifierTypeStateIssuer
1245376375MedicaidVA
405870400MedicaidMD

National Provider Directory

National Provider Directory

Locations

5711 Sarvis Ave
Ste 608
Riverdale Park, MD 20737
Phone (240) 667-1855

6911 Richmond Hwy
Ste 266
Alexandria, VA 22306
Phone (703) 718-0931

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1245376375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5711 SARVIS AVE STE 608",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371394",
            "telephone_number": "301-277-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5711 SARVIS AVE STE 608",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371394",
            "telephone_number": "301-277-4337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6911 Richmond Hwy Ste 266",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223061844",
            "country_code": "US",
            "telephone_number": "703-718-0931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "KABERT",
        "authorized_official_first_name": "GUILLAUME",
        "authorized_official_middle_name": "SERY",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "301-277-4337"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "DC",
            "license": "039714600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245376375",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405870400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.