Organization
PROVIDENTIAL FACILITY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH COY RANDOLPF JR. (OWNER)
(252) 902-2617
Entity
Organization
Contact information
Practice address
611 FORD ST, GREENVILLE, NC 27834-2935
(252) 902-2617
Mailing address
1714 GLENVIEW DR, GREENVILLE, NC 27834-9680
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/11/2011
Last updated
04/11/2011
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