Providian

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

Legal business name

PROVIDIAN

Practice address

2844 E River Rd
Moraine, OH 45439-1538

Phone

(937) 603-6643

NPI assigned

Jun 4, 2009

Last updated

Jun 4, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

THE MUSTARD SEED FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Ms. Shondale Nicole Atkinson

Title

C.E.O.

Phone

(937) 603-6643

Specialties & licenses 1

Addresses

Part of

The Mustard Seed Foundation

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• The Mustard Seed Foundation

  • Mental Illness Community Based Residential Treatment Facility
  • Trotwood, OH
  • NPI 1316365927
  NPPES parent name

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1750517793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 KATY LN",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453222302",
            "telephone_number": "937-603-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2844 E RIVER RD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391538",
            "telephone_number": "937-603-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDIAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MUSTARD SEED FOUNDATION",
        "enumeration_date": "2009-06-04",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "ATKINSON",
        "authorized_official_first_name": "SHONDALE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "937-603-6643",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Project Cure, Inc.
• Providence Health Partners (Center for Clinical Research)
• Providence Medical Group (PMG Lab)
• Providence Medical Group
• Providence Medical Group, Inc. (PMG Vascular Imaging)
• Trudy Eileen Prugh, M.S. PCC-S
• Kimberly Pruitt
• Patrice Puhl
• Amita Lee Pujara, M.S., PC, NCC
• Christina M Pusecker, BA/LPC

• Public Health or Welfare Agency in Moraine, OH
• Providers in Moraine, OH by specialty
• Public Health or Welfare Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; 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.