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Organization
PROVIDENCE PLACE, INC
Active
Organization
PROVIDENCE PLACE, INC
Active
Other names
PROVIDENCE PLACE FAMILY CARE HOME
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOSES OLADAPO OLANREWAJU PH.D. (CEO/ADMINISTRATOR)
(919) 767-9037
Entity
Organization
Contact information
Practice address
916 CLAYTON RD, DURHAM, NC 27703-2608
(919) 767-9037
(919) 767-9037
Mailing address
156 WOLFSNARE LN, MORRISVILLE, NC 27560-7061
(919) 650-1725
(919) 767-9137
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-032-422
NC
Other
Enumeration date
02/20/2008
Last updated
02/20/2008
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