Providence House Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVIDENCE HOUSE INC

Practice address

4802 Deanwood Dr
Capitol Heights, MD 20743-1129

Phone

(973) 444-1983

Fax

(443) 584-4022

NPI assigned

Aug 8, 2022

Organization subpart

No

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

Authorized official

Name

Anthony Jerome Anderson, PHD

Title

Ceo

Phone

(973) 444-1983

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659916800000",
    "number": "1710614870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 DEANWOOD DR",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207431129",
            "telephone_number": "973-444-1983",
            "fax_number": "443-584-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 DEANWOOD DR",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207431129",
            "telephone_number": "973-444-1983",
            "fax_number": "443-584-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-08",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "973-444-1983",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tony@provhouseinc.com",
            "affiliation": "N",
            "endpointDescription": "Business email Address of CEO",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4802 Deanwood Dr",
            "city": "Capitol Heights",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207431129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.