PROVIDENTIAL FACILITY SERVICES, LLC (NPI# 1144510157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144510157 |
| Entity Type | Organization |
| Organization Name | PROVIDENTIAL FACILITY SERVICES, LLC |
| Practice Address |
611 Ford St Greenville NC 27834-2935 |
| Mailing Address |
1714 Glenview Dr Greenville NC 27834-9680 |
| Practice Telephone | 2529022617 |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |
| Authorized Official Name | JOSEPH COY RANDOLPF JR. (OWNER) |
| Authorized Official Telephone | 2529022617 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
611 FORD ST |
| City | GREENVILLE |
| State | NC |
| Zip Code | 27834-2935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801255 | Nicholas Mcarthur Bennett | Day Training, Developmentally Disabled Services | 302 C, Greenville, NC 27834 | 2020-08-11 |
| 1275150245 | Shelby Renee Jones | Student in an Organized Health Care Education/Training Program | East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 | 2020-06-25 |
| 1194347138 | Soban Ahmad | Student in an Organized Health Care Education/Training Program | 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 | 2020-05-13 |
| 1427687789 | Brandon Allen Yates | Student in an Organized Health Care Education/Training Program | 435 Clinic Drive, Greenville, NC 27834 | 2020-04-07 |
| 1144854407 | Kristen Springer Dreyfus | Marriage & Family Therapist | 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 | 2020-02-26 |
| 1861038606 | Southern Surgical Outpatient Surgery Center, Pa | Clinic/Center | 2457 Emerald Place, Greenville, NC 27834 | 2019-11-26 |
| 1003460569 | Shaun Fitzpatrick | Nurse Practitioner | Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 | 2019-08-01 |
| 1649831496 | Katherine Salome Ross | Genetic Counselor, MS | 524 Moye Blvd, Greenville, NC 27834 | 2019-06-24 |
| 1477011880 | Lauren Bethune Scroggs | Counselor | 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 | 2019-03-05 |
| 1669998001 | Idella's Care Home | Community/Behavioral Health | 2912 Lee Ct # 9a, Greenville, NC 27834 | 2017-08-17 |
| Find all providers in zip 27834 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039244 | Amberdawn E Kenworthy-byers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3746 Hickory Ln, Greenville, OH 45331-3014 | 2020-09-23 |
| 1245855352 | Giving Hope Supportive Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 305 Shada Ln, Greenville, SC 29611-2068 | 2020-06-15 |
| 1629328943 | Pitt County Group Home Board for Mentally Retarded, Autistic Persons | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1203 Red Banks Rd, Greenville, NC 27858-5302 | 2012-09-13 |
| 1912266396 | Serenity Care With Love, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1205 B 8 Crosscreek Circle, Greenville, NC 27834 | 2012-05-07 |
| 1871656504 | Rha Health Services Nc, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 500 Sean Dr, Greenville, NC 27834-7839 | 2006-12-17 |
| 1437246345 | Heavenly Arms LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2470 Emerald Pl, Suite D, Greenville, NC 27834-5786 | 2006-10-10 |
| 1477646099 | Height Home LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 601-a Country Club Drive, Greenville, NC 27834 | 2006-10-02 |
| 1720287493 | New Start of North Carolina | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 708 W 14th Ave, Greenville, NC 27834-3083 | 2007-07-13 |
| 1639378300 | New Start of North Carolina | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 708 W 14th Ave, Greenville, NC 27834-3083 | 2007-07-13 |
| 1629277397 | New Start of North Carolina | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 708 W 14th Ave, Greenville, NC 27834-3083 | 2007-07-13 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 27834 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.