Providence Healthcare Services, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PROVIDENCE HEALTHCARE SERVICES, LLC

Practice address

220 I St NE Ste 110
Washington, DC 20002-4365

Phone

(202) 486-1894

NPI assigned

Mar 30, 2019

Last updated

Oct 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adelaide Etse

Title

Cfo

Phone

(301) 841-8907

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1821559865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 I ST NE STE 110",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200024365",
            "telephone_number": "202-486-1894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 I ST NE STE 110",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200024365",
            "telephone_number": "202-486-1894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-30",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "ETSE",
        "authorized_official_first_name": "ADELAIDE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-841-8907"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF BEHAVIORAL HEALTH",
            "identifier": "070220-430",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Providence Health Services, Inc (PHS Occupational Health/Wellness)
• Providence Health Services, Inc
• Providence Health Services, Inc (PHS Unity Healthcare Parkside Radiology)
• Providence Health Services, Inc (PHS Anesthesia)
• Providence Health Services, Inc (PHS GYN Group)
• Providence Hospital
• Providence Hospital
• Providence Hospital
• Providence Hospital
• Providence Hospital (Providence Urgent Care Center)

• Substance Use Disorder Rehabilitation Clinic/Center in Washington, DC
• Providers in Washington, DC by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.