Organization
PROVIDENCE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES E COBLE JR. (EXECUTIVE DIRECTOR)
(410) 766-2212
Entity
Organization
Contact information
Practice address
8223 CLOVERLEAF DR, MILLERSVILLE, MD 21108-1534
(443) 679-1166
Mailing address
930 POINT PLEASANT RD, GLEN BURNIE, MD 21060-6604
(410) 766-2212
(443) 577-0215
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
DDA-4049-00
MD
Other
Enumeration date
05/09/2007
Last updated
07/30/2007
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