Providence Home

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

PROVIDENCE HOME

Practice address

8108 Modesto Dr
Arlington, TX 76001-8545

Phone

(817) 715-0236

NPI assigned

May 20, 2010

Organization subpart

No

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

Authorized official

Name

Saaghe Mmbi Fogwe

Title

Owner/Manager

Phone

(817) 715-0236

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1700105426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8108 MODESTO DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760018545",
            "telephone_number": "817-715-0236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8108 MODESTO DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760018545",
            "telephone_number": "817-715-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-20",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "FOGWE",
        "authorized_official_first_name": "SAAGHE",
        "authorized_official_middle_name": "MMBI",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "817-715-0236"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Arlington, TX
• Providers in Arlington, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.