Organization
PROVIDENCE COMMUNITY SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN THOMAS EDWARDS (C.E.O)
(804) 674-1044
Entity
Organization
Contact information
Practice address
7011 EGAN PL, CHESTERFIELD, VA 23832-8310
(804) 674-1044
(804) 674-1110
Mailing address
7011 EGAN PL, CHESTERFIELD, VA 23832-8310
(804) 674-1044
(804) 674-1110
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
225301001
VA
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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