Providence Care Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

060-R-1019 Issued in GA

Legal business name

PROVIDENCE CARE INC

Practice address

216 NW Broad St Ste B
Fairburn, GA 30213-4106

Phone

(678) 489-2069

Fax

(678) 489-8627

NPI assigned

Jun 13, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Stella Ngozi Okpala, PHARM.DNPI 1578889119

Title

Director/Owner

Phone

(404) 931-7854

Specialties & licenses 1

Addresses

Other names 1

• providence private care home and providence community living arrangem Former legal business name

Locations

Practitioners 2

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

• Stella Ngozi Okpala

  • Pharmacotherapy Pharmacist
  • Fairburn, GA
  • NPI 1578889119
  NPD (past) Authorized official
• Clement Emeka Okpala, PHARMD

  • Pharmacotherapy Pharmacist
  • Fairburn, GA
  • NPI 1326379280
  NPD (past)

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1376805630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 NW BROAD ST STE B",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134106",
            "telephone_number": "678-489-2069",
            "fax_number": "678-489-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 NW BROAD ST STE B",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134106",
            "telephone_number": "678-489-2069",
            "fax_number": "678-489-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "OKPALA",
        "authorized_official_first_name": "STELLA",
        "authorized_official_middle_name": "NGOZI",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "404-931-7854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "060-R-1019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "providence private care home and providence community living arrangem",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.