Organization
PROVIDENCE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELVIRA N BERRY JD (EXECUTIVE DIRECTOR)
(484) 746-0064
Entity
Organization
Contact information
Practice address
7928 RIDGE AVE, FIRST FLOOR, PHILADELPHIA, PA 19128-3011
(484) 746-0064
Mailing address
7928 RIDGE AVE, FIRST FLOOR, PHILADELPHIA, PA 19128-3011
(484) 746-0064
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CER-00092467
PA
311ZA0620X
Adult Care Home Facility
CER-00092467
PA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
CER-00092467
PA
Other
Enumeration date
03/30/2016
Last updated
05/26/2016
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