Organization
PROVIDENCE HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY JEROME ANDERSON PHD (CEO)
(973) 444-1983
Entity
Organization
Contact information
Practice address
4802 DEANWOOD DR, CAPITOL HEIGHTS, MD 20743-1129
(973) 444-1983
(443) 584-4022
Mailing address
4802 DEANWOOD DR, CAPITOL HEIGHTS, MD 20743-1129
(973) 444-1983
(443) 584-4022
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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