Organization
PROVIDENCE PLACE LLC
Active
Parent organization
PROVIDENCE PLACE LLC
Other names
Cotton Grove Estate
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE PLACE LLC
Authorized official
STEPHANIE CHADWICK (OWNER)
(912) 415-1313
Entity
Organization
Contact information
Practice address
249 JOE NAIA RD, JESUP, GA 31545-4112
(912) 415-1313
Mailing address
249 JOE NAIA RD, JESUP, GA 31545-4112
(912) 415-1313
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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