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Providence Service Corporation

Organization Active NPI Community/Behavioral Health Agency · Springvale, ME

NPI 1982949699 · NPPES record last updated Dec 6, 2012

Key facts

NPI
1982949699
Entity type
Organization (NPI type 2)
Primary specialty
Community/Behavioral Health Agency 251S00000X
License
392123 (ME)
Legal business name
PROVIDENCE SERVICE CORPORATION
Practice address
469 Main St
Springvale, ME 04083-1870
Phone
(207) 490-6600
NPI assigned
Dec 6, 2012
Organization subpart
No

Authorized official

Name
Nicole Zenga
Title
Director of Operations
Phone
(207) 373-0620

Corporate family (same tax ID) 9

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Pathways of Maine Inc (10 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 392123 ME Yes

Addresses

Primary practice location

469 Main St
Springvale, ME 04083-1870

Mailing address

PO Box 758866
Baltimore, MD 21275-8866

Other identifiers

IdentifierTypeStateIssuer
19170000MedicaidME

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2012.

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1982949699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758866",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212758866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 MAIN ST",
            "city": "SPRINGVALE",
            "state": "ME",
            "postal_code": "040831870",
            "telephone_number": "207-490-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "ZENGA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "207-373-0620"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ME",
            "license": "392123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19170000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springvale, ME

All providers in Springvale, ME · Community/Behavioral Health Agency in Maine

Sources for this page

Verify at the official NPI Registry.