Organization
PROVIDENCE PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOSES OLADAPO OLANREWAJU (PRESIDENT)
(919) 767-9037
Entity
Organization
Contact information
Practice address
916 CLAYTON RD, DURHAM, NC 27703-2608
(919) 767-9037
(919) 768-1090
Mailing address
156 WOLFSNARE LN, MORRISVILLE, NC 27560-7061
(919) 768-1090
(919) 768-1090
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-032-422
NC
Other
Enumeration date
01/10/2007
Last updated
02/15/2008
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