Providence Service, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROVIDENCE SERVICE, LLC

Practice address

2530 W Allens Peak Dr
Queen Creek, AZ 85142-4642

Phone

(615) 668-4485

Fax

(480) 812-3131

NPI assigned

Jun 25, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Olayinka O Osinloye, NP

Title

FNP/Pmhnp

Phone

(615) 668-4485

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Providence Service, LLC Doing business as

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1245593268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 W ALLENS PEAK DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851424642",
            "telephone_number": "615-668-4485",
            "fax_number": "480-812-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 W ALLENS PEAK DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851424642",
            "telephone_number": "615-668-4485",
            "fax_number": "480-812-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "OSINLOYE",
        "authorized_official_first_name": "OLAYINKA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "FNP/PMHNP",
        "authorized_official_telephone_number": "615-668-4485",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TN",
            "license": "APN0000015886",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1524996",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z181765",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Service, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; 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.