PROVIDENCE SERVICE CORPORATION (NPI# 1821003658) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821003658 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE SERVICE CORPORATION |
| Practice Address |
4645 W Gore Blvd Suite 5 Lawton OK 73505-6041 |
| Practice Telephone | 5803556800 |
| Mailing Telephone | 5803556800 |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. AGLAIA 'ALEXIS' MARTIN (THERAPIST) |
| Authorized Official Telephone | 5803556800 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251K00000X | Public Health or Welfare | 2560 | OK | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447404082 | Providence Service Corporation | Exclusive Provider Organization | 2211 E Missouri Ave, E243, El Paso, TX 79903-3807 | 2008-11-10 |
| 1851728042 | Providence Service Corporation | Community/Behavioral Health | 2215 N Broadway, Santa Ana, CA 92706-2663 | 2013-10-02 |
| 1982949699 | Providence Service Corporation | Community/Behavioral Health | 469 Main St, Springvale, ME 04083-1870 | 2012-12-06 |
| 1710222534 | Providence Service Corporation | Community/Behavioral Health | 2 Davenport Cir, Suite 4; Achieve Program, Bath, ME 04530-2880 | 2012-12-05 |
| 1235271222 | Providence Service Corporation | Case Management | 301 N High St, Antlers, OK 74523-2238 | 2007-02-13 |
| Street Address |
4645 W GORE BLVD SUITE 5 |
| City | LAWTON |
| State | OK |
| Zip Code | 73505-6041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881645604 | Stacy Elizabeth Mcglory | Occupational Therapist | 4645 W Gore Blvd, Suite E, Lawton, OK 73505-6041 | 2006-05-15 |
| 1902043557 | Christopher Paul Juneau | Physical Therapist | 4645 W Gore Blvd, Suite E, Lawton, OK 73505-6041 | 2009-01-17 |
| 1124283064 | Oklahoma Physical Therapy Lawton Spine Care Sports Rehab LLC | Physical Therapist | 4645 W Gore Blvd, Suite E, Lawton, OK 73505-6041 | 2008-07-21 |
| 1063555977 | Manuela Wikinger-henry | Marriage & Family Therapist | 4645 W Gore Blvd, Suite 5, Lawton, OK 73505-6041 | 2007-02-14 |
| 1972685469 | Jimmy Royce Stanton Jr. | Physical Therapist | 4645 W Gore Blvd, Suite E, Lawton, OK 73505-6041 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134744006 | Angela Janell Smith | Case Manager/Care Coordinator | 4904 Nw Smith Ave, Lawton, OK 73505 | 2020-06-16 |
| 1295383990 | Akeemia Lorene Holder | Case Manager/Care Coordinator | Youth Care of Oklahoma, 713 Sw C Avenue, OK 73505 | 2019-08-27 |
| 1225685480 | Healthstat Onsite Clinic Goodyear Vision Center | Preventive Medicine | 1 Goodyear Blvd, Lawton, OK 73505 | 2019-08-22 |
| 1891285300 | Michael Anthony Gray | Case Manager/Care Coordinator | 2218 Nw 36th St, Lawton, OK 73505 | 2018-05-10 |
| 1841797362 | Adeshola T Fatuyi | Case Manager/Care Coordinator | 7301 Sw Lee 635, Lawton, OK 73505 | 2018-04-11 |
| 1912425539 | Heather Shea Morefield | Case Manager/Care Coordinator | 2712 Sw H Ave, Lawton, OK 73505 | 2017-09-04 |
| 1972031367 | Burke Hendricks | Emergency Medicine | 3401 West Gore Boulevard, Lawton, OH 73505 | 2017-05-30 |
| 1932642279 | Helery Vance | Peer Specialist | 1420 Nw Hunter Rd Apt C7, Lawton, OK 73505 | 2016-11-18 |
| 1629523436 | Sebrina Sheppard | Case Manager/Care Coordinator | 3907 Sw Parkridge Blvd., Lawton, OK 73505 | 2016-08-22 |
| 1376913590 | David Lee Atauvich | Registered Nurse | 1515 Lawrie Rd, Lawton, OK 73505 | 2015-09-30 |
| Find all providers in zip 73505 | ||||
| Taxonomy Code | 251K00000X |
| Grouping | Agencies |
| Classification | Public Health or Welfare |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710122833 | Provide Hearing Aids | Public Health or Welfare | 1201 West Gore Blvd, Suite D, Lawton, OK 73501 | 2008-12-03 |
| 1538114038 | Lawtonka Counseling Services, Inc. | Public Health or Welfare | 813 Sw B Ave, C, Lawton, OK 73501-3954 | 2006-05-23 |
| 1265493837 | Lawton Independent School District | Public Health or Welfare | 753 Nw Fort Sill Blvd, Lawton, OK 73507-5421 | 2006-03-31 |
| 1053352690 | Comanche County Healthcare Corporation | Public Health or Welfare | 3811 W Gore Blvd, Suite 2, Lawton, OK 73505 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174044002 | Terrie Dawn Talbot | Public Health or Welfare | 500 W Chincapin St, Westville, OK 74965-0410 | 2017-06-30 |
| 1992240261 | Caring Nurses Association LLC | Public Health or Welfare | 5520 S Memorial Dr, Tulsa, OK 74145-9018 | 2016-12-22 |
| 1477009090 | Oklahoma State Deptartment of Health | Public Health or Welfare | 804 N. 7th St, Perry, OK 73077 | 2016-09-01 |
| 1649630856 | Connie Russell | Public Health or Welfare | 502 S Choctaw Ave, Wapanucka, OK 73461-9235 | 2016-03-01 |
| 1124485263 | Oklahoma City County Health Department | Public Health or Welfare | 2700 Ne 63rd Street, Oklahoma City, OK 73111 | 2016-01-20 |
| 1144616061 | Heart Therapy | Public Health or Welfare | 711 W. Main St., Norman, OK 73069 | 2015-04-07 |
| 1467856153 | David Deere | Public Health or Welfare | 17713 S Sante Fe Pl, Mounds, OK 74047 | 2014-10-09 |
| 1063761476 | Hanna Public School | Public Health or Welfare | 2nd and Huls, Hanna, OK 74845 | 2012-08-30 |
| 1649529066 | Frink-chambers Elementary School | Public Health or Welfare | 4610 Frink Road, Mcalester, OK 74502-6367 | 2012-08-30 |
| 1063769867 | Stidham School | Public Health or Welfare | 1st and Main, Stidham, OK 74461 | 2012-08-10 |
| Find all providers with the same taxonomy | ||||
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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.