NPIMap

Organization Active NPI

Providence Service, LLC

  • Clinic/Center
  • Queen Creek, AZ
National Provider Identifier
1245593268
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROVIDENCE SERVICE, LLC
Doing business as
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
Last updated
Nov 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Authorized official

Name
Mrs. Olayinka O Osinloye, NPNPI 1518246214
Title
FNP/Pmhnp
Phone
(615) 668-4485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X APN0000015886 TN
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

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

Mailing address

2530 W Allens Peak Dr
Queen Creek, AZ 85142-4642
Phone (615) 668-4485

Other names 1

  • Providence Service, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Service, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Queen Creek, AZ

Sources for this page

  • 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.