Organization
PROVIDENCE HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE ENI CHICK FOH (DIRECTOR)
(202) 506-0695
Entity
Organization
Contact information
Practice address
8009 GOSPORT LN, SPRINGFIELD, VA 22151-2008
(202) 506-0695
Mailing address
8009 GOSPORT LN, SPRINGFIELD, VA 22151-2008
(202) 506-0695
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/14/2019
Last updated
06/14/2019
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