Provident Arc LLC

Primary specialty

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

License

954 Issued in VA

Legal business name

PROVIDENT ARC LLC

Practice address

17300 River Ridge Blvd
Suite 301
Woodbridge, VA 22191-5167

Phone

(703) 861-4409

NPI assigned

Mar 11, 2010

Organization subpart

No

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

Authorized official

Name

Reynaldo Roundtree

Title

Co-Owner

Phone

(703) 861-4409

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1285957761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 RIVER RIDGE BLVD",
            "address_2": "SUITE 301",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221915167",
            "telephone_number": "703-861-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 RIVER RIDGE BLVD",
            "address_2": "SUITE 301",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221915167",
            "telephone_number": "703-861-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT ARC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "ROUNDTREE",
        "authorized_official_first_name": "REYNALDO",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "703-861-4409"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.