# PROVIDENCE PLACE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558411942
- **Authorized official:** DR. MOSES OLADAPO OLANREWAJU (PRESIDENT)
- **Authorized official phone:** (919) 767-9037

## Contact information

- **Practice address:** 916 CLAYTON RD, DURHAM, NC 27703-2608
- **Practice address phone:** (919) 767-9037
- **Practice address fax:** (919) 768-1090
- **Mailing address:** 156 WOLFSNARE LN, MORRISVILLE, NC 27560-7061
- **Mailing address phone:** (919) 768-1090
- **Mailing address fax:** (919) 768-1090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-032-422 | NC | Yes |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 02/15/2008