Providence Service Corporation

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

PROVIDENCE SERVICE CORPORATION

Practice address

2211 E Missouri Ave
E243
El Paso, TX 79903-3807

Phone

(915) 545-8137

Fax

(915) 838-1772

NPI assigned

Nov 10, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Richard Wallace, LCSW

Title

State Executive Director

Phone

(512) 343-8606

Specialties & licenses 1

Addresses

Tax ID family

Providence Service Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Service Corporation of Texas

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Austin, TX
  • NPI 1215007141
  NPD tax ID

Locations

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226275200000",
    "number": "1447404082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 E MISSOURI AVE",
            "address_2": "E243",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799033807",
            "telephone_number": "915-545-8137",
            "fax_number": "915-838-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 E MISSOURI AVE",
            "address_2": "E243",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799033807",
            "telephone_number": "915-545-8137",
            "fax_number": "915-838-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-10",
        "last_updated": "2008-11-10",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "STATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "512-343-8606",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Provencio Enterprises Incorporated
• Provencio Enterprises Incorporated
• Mauro Provencio, M.D.
• Tracy Lynn Provenghi, DDS
• Providence Imaging Consultants, P.a.
• Provident Eye Specialists, PA
• Jessica Estelle Provine
• Provision Home Care Agency LLC
• Theresa M. Prudencio, OTR
• Yessenia Marie Pruett, LCSW

• Exclusive Provider Organization in El Paso, TX
• Providers in El Paso, TX by specialty
• Exclusive Provider Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; 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.