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Organization

PROVIDENCE PLACE, INC

Active
Other names
PROVIDENCE PLACE FAMILY CARE HOME
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MOSES OLADAPO OLANREWAJU PH.D. (CEO/ADMINISTRATOR)
(919) 767-9037
Entity
Organization

Contact information

Practice address
916 CLAYTON RD, DURHAM, NC 27703-2608
(919) 767-9037
(919) 767-9037
Mailing address
156 WOLFSNARE LN, MORRISVILLE, NC 27560-7061
(919) 650-1725
(919) 767-9137

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-032-422
NC

Other

Enumeration date
02/20/2008
Last updated
02/20/2008
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