# THE PROVIDENCIA GROUP

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

## Provider details

- **NPI number:** 1972362796
- **Authorized official:** KEVIN MARQUEZ (CEO)
- **Authorized official phone:** (571) 223-4629

## Contact information

- **Practice address:** 19775 BELMONT EXECUTIVE PLZ STE 450, ASHBURN, VA 20147-7606
- **Practice address phone:** (571) 431-1458
- **Mailing address:** 7773 WAIKAPU LOOP, HONOLULU, HI 96825-3026
- **Mailing address phone:** (808) 282-1840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2024
- **Last updated:** 03/14/2024