Organization
PROVIDENCE SUPPORT SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE MARIE RODDEN LMSW (DIRECTOR OF QUALITY ASSURANCE)
(505) 898-9435
Entity
Organization
Contact information
Practice address
8328 CALLE PRIMERA NW, ALBUQUERQUE, NM 87120-5386
(505) 898-9435
(505) 898-9052
Mailing address
8328 CALLE PRIMERA NW, ALBUQUERQUE, NM 87120-5386
(505) 898-9435
(505) 898-9052
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
68929072
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68929072
PROVIDER NUMBER
NM
Enumeration date
05/05/2007
Last updated
08/22/2020
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