Providence Corporation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CER-00092467 Issued in PA

Legal business name

PROVIDENCE CORPORATION

Practice address

7928 Ridge Ave
First Floor
Philadelphia, PA 19128-3011

Phone

(484) 746-0064

NPI assigned

Mar 30, 2016

Last updated

May 26, 2016By 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

Elvira N Berry, JD

Title

Executive Director

Phone

(484) 746-0064

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1518320373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7928 RIDGE AVE",
            "address_2": "FIRST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191283011",
            "telephone_number": "484-746-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7928 RIDGE AVE",
            "address_2": "FIRST FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191283011",
            "telephone_number": "484-746-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "ELVIRA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "484-746-0064",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "PA",
            "license": "CER-00092467",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "PA",
            "license": "CER-00092467",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "CER-00092467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.