PH Providence, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PH PROVIDENCE, LLC

Practice address

401 E 20TH St
Covington, KY 41014-1583

Phone

(845) 732-9410

NPI assigned

Oct 22, 2014

Organization subpart

No

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

Authorized official

Name

Benjamin Klein

Title

Manager

Phone

(847) 329-4100

Specialties & licenses 1

Addresses

Other names 1

• Providence Pavilion Doing business as

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1851795686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7444 LONG AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773214",
            "telephone_number": "847-329-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 20TH ST",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410141583",
            "telephone_number": "845-732-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PH PROVIDENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-329-4100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abigail Peed, RRT
• La Saundra Pendleton, M.S., CCC-SLP
• Shannon Pernell, R.N.
• Jon Clayton Perry
• Britney Pfister, B.A.
• Marc Todd Philippe, M.D.
• Megan Phillabaum, DMD
• Kerri Phillips, LCSW
• Lauren R Plageman, DNP
• Sally Ann Plummer-Bratton, LPCC

• Skilled Nursing Facility in Covington, KY
• Providers in Covington, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; 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.