NPIMap

Organization Active NPI

Providence Place, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Durham, NC
National Provider Identifier
1801064118
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
MHL-032-422 Issued in NC
Legal business name
PROVIDENCE PLACE, INC
Practice address
916 Clayton Rd
Durham, NC 27703-2608
Phone
(919) 767-9037
Fax
(919) 767-9037
NPI assigned
Feb 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Dr. Moses Oladapo Olanrewaju, PH.D.
Title
Ceo/Administrator
Phone
(919) 767-9037

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X MHL-032-422 NC Primary

Addresses

Primary practice location

916 Clayton Rd
Durham, NC 27703-2608

Mailing address

156 Wolfsnare LN
Morrisville, NC 27560-7061
Phone (919) 650-1725

Other names 1

  • PROVIDENCE PLACE FAMILY CARE HOME Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Providence Place Family Care Home2 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.

NPI Registry JSON

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1801064118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WOLFSNARE LN",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275607061",
            "telephone_number": "919-650-1725",
            "fax_number": "919-767-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 CLAYTON RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277032608",
            "telephone_number": "919-767-9037",
            "fax_number": "919-767-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PLACE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "OLANREWAJU",
        "authorized_official_first_name": "MOSES",
        "authorized_official_middle_name": "OLADAPO",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "919-767-9037",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-032-422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE PLACE FAMILY CARE HOME",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.