Organization
PROVIDENCE HEALTHCARE SERVICES, LLC
Active
Organization
PROVIDENCE HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADELAIDE ETSE (CFO)
(301) 841-8907
Entity
Organization
Contact information
Practice address
220 I ST NE STE 110, WASHINGTON, DC 20002-4365
(202) 486-1894
Mailing address
220 I ST NE STE 110, WASHINGTON, DC 20002-4365
(202) 486-1894
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070220-430
DEPARTMENT OF BEHAVIORAL HEALTH
DC
Enumeration date
03/30/2019
Last updated
10/28/2020
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