Providence Healthcare Services, LLC

Primary specialty

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

Legal business name

PROVIDENCE HEALTHCARE SERVICES, LLC

Practice address

8009 Gosport LN
Springfield, VA 22151-2008

Phone

(202) 506-0695

NPI assigned

Jun 14, 2019

Last updated

Jun 14, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Constance Eni Chick Foh

Title

Director

Phone

(202) 506-0695

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1427618255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8009 GOSPORT LN",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221512008",
            "telephone_number": "202-506-0695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8009 GOSPORT LN",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221512008",
            "telephone_number": "202-506-0695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "CHICK FOH",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "ENI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "202-506-0695"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Springfield, VA
• Providers in Springfield, 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 Jun 14, 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.