Providence Center, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

DDA-4049-00 Issued in MD

Legal business name

PROVIDENCE CENTER, INC.

Practice address

8223 Cloverleaf Dr
Millersville, MD 21108-1534

Phone

(443) 679-1166

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Charles E Coble Jr.

Title

Executive Director

Phone

(410) 766-2212

Specialties & licenses 1

Addresses

Tax ID family

Providence Center Inc2 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 Center, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Arnold, MD
  • NPI 1194937292
  NPD tax ID

Locations

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1801000955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 POINT PLEASANT RD",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210606604",
            "telephone_number": "410-766-2212",
            "fax_number": "443-577-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8223 CLOVERLEAF DR",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081534",
            "telephone_number": "443-679-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "COBLE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-766-2212",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "MD",
            "license": "DDA-4049-00",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Porter, LCSW-C
• Mariah Postupack
• Renata M Powell, LCPC
• Alyssa Ruth Pravetz, LMSW
• Pauline Prince, PH.D.
• Janiya McKenzie Queen
• Taylor Ramdeen, RD
• Mahrukh Rauf
• Keilani Rebollo
• Monica Redmond, LGPC

• Developmentally Disabled Services Day Training Agency in Millersville, MD
• Providers in Millersville, MD by specialty
• Developmentally Disabled Services Day Training Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.