PROVIDENCE HEALTH SERVICES, INC (NPI# 1609031632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609031632 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SERVICES, INC |
| Other Organization Name | PHS OUTPATIENT BEHAVIORAL HEALTH |
| Practice Address |
1140 Varnum St Ne Ste 100 Washington DC 20017 |
| Mailing Address |
1150 Varnum St Ne St Catherines Hall 102 Washington DC 20017-2180 |
| Practice Telephone | 2028547623 |
| Practice Fax Number | 2028547616 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2022697825 |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2018-08-22 |
| Authorized Official Name | BEAU HIGGINBOTHAM (VICE PRESIDENT/COO) |
| Authorized Official Telephone | 4103683162 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| N | 2084B0040X |
Psychiatry & Neurology Specialization: Behavioral Neurology & Neuropsychiatry |
HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| N | 101Y00000X | Counselor | HFD01-0212 | DC | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | HFD01-0212 | DC | Behavioral Health & Social Service Providers |
| N | 104100000X | Social Worker | HFD01-0212 | DC | Behavioral Health & Social Service Providers |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 985415100 | 05 |
| Other Name | Type Code |
|---|---|
| PHS Outpatient Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356859334 | Providence Health Services, Inc | Specialist | 1150 Varnum St Ne Ste 300, Washington, DC 20017-2180 | 2018-01-12 |
| 1598313595 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-09-03 |
| 1740795293 | Providence Health Services, Inc | Nurse Anesthetist, Certified Registered | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-12-06 |
| 1679087365 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-11-17 |
| 1730690801 | Providence Health Services, Inc | Clinic/Center | 765 Kenilworth Ter Ne, Washington, DC 20019-1898 | 2017-10-17 |
| 1972012615 | Providence Health Services, Inc | Obstetrics & Gynecology | 1150 Varnum St Ne, St Catherine's Hall, 2nd Floor, Washington, DC 20017-2107 | 2017-09-26 |
| 1689005720 | Providence Health Services, Inc | General Acute Care Hospital | 1160 Varnum St Ne, Depaul 312, Washington, DC 20017-2107 | 2013-11-27 |
| 1366710766 | Providence Health Services, Inc | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 200, Washington, DC 20017-2151 | 2011-12-13 |
| 1619245222 | Providence Health Services, Inc | Family Medicine | 128 M St Nw, Washington, DC 20001-1205 | 2011-12-09 |
| Street Address |
1140 VARNUM ST NE STE 100 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588215479 | Janet Achankeng Folem | Psychologist | 7100 Varnum St Ne, Suit 218, Washington, DC 20017 | 2019-09-23 |
| 1013475284 | Raphaelia Agnes Johnson-phillips | Technician | 440 Taylor St. Ne Building B Apt 22, Washington Dc, DC 20017 | 2019-03-06 |
| 1528551413 | Harpreet Saluja | Student in an Organized Health Care Education/Training Program | 1150 Varnum St Ne, Providence Hospital Im Department, Washington, DC 20017 | 2018-06-14 |
| 1134638042 | Jane Hayashi-kim | Speech-Language Pathologist | 3910 9th St Ne, Apartment 3, Washington, DC 20017 | 2017-09-22 |
| 1346766102 | Aaliyah Gabrielle Jones | Technician | 611edgewood Ne, Washington, DC 20017 | 2017-08-14 |
| 1417479197 | Javalin Singh | Home Health Aide | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | 2017-07-13 |
| 1386174175 | Genevieve Wells | Home Health Aide | 601 Edgewood St. Ne, Apt 706, Washington, DC 20017 | 2017-06-14 |
| 1487183810 | Valerie Anne Pierre | Student in an Organized Health Care Education/Training Program | 1150 Varnum Street, N.e., Acc 209, Washington, DC 20017 | 2017-06-08 |
| 1639600984 | Liliana Tatum | Counselor | 1428 Hamlin Street Ne, Washington, DC 20017 | 2017-03-27 |
| 1750835435 | Marie Hortense Mabou Sando | Home Health Aide | 1416 9th Street Nwdc, Washington, DC 20017 | 2016-08-10 |
| Find all providers in zip 20017 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205445996 | Andres Mario Salazar | Psychiatry & Neurology | 3203 Cleveland Ave Nw, Washington, DC 20008-3450 | 2020-07-28 |
| 1063051951 | Susahealth LLC | Psychiatry & Neurology | 1666 Connecticut Ave Nw, Washington, DC 20009-1039 | 2019-12-26 |
| 1609414994 | Rebound Health and Wellness Services Inc | Psychiatry & Neurology | 4645 Nannie Helen Burroughs Ave Ne Ste 101, Washington, DC 20019-3622 | 2019-12-17 |
| 1013335165 | Brian Douglas Barry | Psychiatry & Neurology | 110 Irving St Nw # G-019, Washington, DC 20010-3017 | 2014-04-04 |
| 1548604101 | Sara Siavoshi | Psychiatry & Neurology | 3800 Reservoir Rd Nw # Nwv, Washington, DC 20007-2113 | 2013-04-24 |
| 1316205958 | St. Clair Washington Physician Services | Psychiatry & Neurology | 101 Trich Dr Ste 1, Washington, PA 15301-5989 | 2012-05-02 |
| 1003104209 | Joel Edward Kleinman | Psychiatry & Neurology | 3734 Jenifer St Nw, Washington, DC 20015-1834 | 2011-07-21 |
| 1477840460 | Daniel Roy Weinberger | Psychiatry & Neurology | 3116 Davenport St Nw, Washington, DC 20008-2244 | 2011-06-29 |
| 1619270212 | Jason Warren Freeman | Psychiatry & Neurology | 5215 Loughboro Road, Nw Suite 300, Jhcp At Sibley Medical Office Building, Washington, DC 20016-2695 | 2010-12-21 |
| 1477791960 | Alan I. Faden | Psychiatry & Neurology | 5430 Chevy Chase Pkwy Nw, Washington, DC 20015-1706 | 2009-01-22 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
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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.