Providence Living LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PROVIDENCE LIVING LLC

Practice address

1528 Walnut St Ste 1410
Philadelphia, PA 19102-3610

Phone

(484) 445-4145

Fax

(888) 373-9844

NPI assigned

Apr 13, 2019

Organization subpart

No

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

Authorized official

Name

Dr. William Heran, PHD, LCSW

Title

Ceo

Phone

(484) 445-4145

Specialties & licenses 5

Addresses

Other names 1

• Providence Treatment Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Providence Living LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Living LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Media, PA
  • NPI 1730562711
  NPD tax ID
• Providence Living LLC

  • Substance Abuse Rehabilitation Facility
  • Honolulu, HI
  • NPI 1003413097
  NPD tax ID
• Providence Living LLC

  • Substance Abuse Rehabilitation Facility
  • Boston, MA
  • NPI 1942920459
  NPD tax ID

Locations

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

{
    "created_epoch": "1555113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1962965145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST STE 1410",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023610",
            "telephone_number": "484-445-4145",
            "fax_number": "888-373-9844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST STE 1410",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023610",
            "telephone_number": "484-445-4145",
            "fax_number": "888-373-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-13",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "HERAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "484-445-4145",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Treatment",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carol A Proud, CRNP
• Elizabeth Parks Prout, MD
• Margaret Mary Provencher, MD
• Noelle Provenzano
• Providence Corporation
• Providers Choice Ambulance Service Inc.
• Courtney Ann Provine, CRNP
• Provision Point LLC
• Provisional 2 Preferred Living 4 Ever 62 Inc.
• Provisions Home Healthcare Services,LLC

• Substance Use Disorder Rehabilitation Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.