Organization
PROVIDENCE SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY O ADEBAYO N/A (PRESIDENT)
(732) 322-3924
Entity
Organization
Contact information
Practice address
3 RIDGEWOOD DR, BORDENTOWN, NJ 08505-4737
(732) 322-3924
(267) 841-7275
Mailing address
3 RIDGEWOOD DR, BORDENTOWN, NJ 08505-4737
(732) 322-3924
(267) 841-7275
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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