PROVIDENCE LIVING LLC (NPI# 1962965145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962965145 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE LIVING LLC |
| Other Organization Name | PROVIDENCE TREATMENT |
| Practice Address |
1528 Walnut St Ste 1410 Philadelphia PA 19102-3610 |
| Practice Telephone | 4844454145 |
| Practice Fax Number | 8883739844 |
| Mailing Telephone | 4844454145 |
| Mailing Fax Number | 8883739844 |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | DR. WILLIAM HERAN (CEO) |
| Authorized Official Telephone | 4844454145 |
| Authorized Official Credential | PHD, LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Providence Treatment | Doing Business As Name - Organization |
| Providence Treatment | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003413097 | Providence Living LLC | Substance Abuse Rehabilitation Facility | 1188 Bishop St Ste 1008, Honolulu, HI 96813-3304 | 2020-10-03 |
| 1053874230 | Providence Living LLC | Substance Abuse Rehabilitation Facility | 355 Lancaster Ave Ste 303, Haverford, PA 19041-1502 | 2019-04-13 |
| 1730562711 | Providence Living LLC | Counselor | 280 N Providence Rd Ste 2, Media, PA 19063-3525 | 2015-07-08 |
| Street Address |
1528 WALNUT ST STE 1410 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19102-3610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821650847 | Alexandre Mason Sharma | Student in an Organized Health Care Education/Training Program | 200 N 16th St Apt 1318, Philadelphia, PA 19102 | 2019-06-29 |
| 1720648223 | Ali Haydar | Internal Medicine | 245 N. 15th St, 6th Floor, Ms 42, Philadelphia, PA 19102 | 2019-06-17 |
| 1124688734 | Aakash Patel | Internal Medicine | Drexel University College of Medicine-internal Medicine, 245 N. 15th St. 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-17 |
| 1245898170 | Parth Javia | Internal Medicine | 245 N. 15th St., 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-05 |
| 1588120968 | John Granger II | Social Worker | 1500 Market St. 12th Floor Suite 75, Philadelphia, PA 19102 | 2019-02-11 |
| 1750851390 | Philadelphia Pain and Neurology Institute, LLC | Chiropractor | 1528 Walnut Street Suite 620, Philadelphia, PA 19102 | 2018-11-27 |
| 1770076465 | Sarthi Dalal | Internal Medicine | 245 N 15th St, Fl 6, Ms 427, Philadelphia, PA 19102 | 2018-06-07 |
| 1255824033 | Joyce Nimo-boampong | Internal Medicine | Drexel University College of Medicine, 245 N 15th St, 6th Floor,ms 427, Philadelphia, PA 19102 | 2018-06-07 |
| 1134625692 | Emma Rose Gormley | Social Worker | 1601 Walnut St Ste 1516, Philadelphia, PA 19102 | 2018-04-03 |
| 1851808497 | Sunish Shah | Pharmacist | 230 N Broad St, Philadelphia, Pa 19102, Philadelphia, PA 19102 | 2018-01-04 |
| Find all providers in zip 19102 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265933931 | Teen Challenge Training Center, Inc. | Substance Abuse Rehabilitation Facility | 329 E Wister St, Philadelphia, PA 19144-1828 | 2018-02-27 |
| 1689190746 | Why Not Prosper Inc | Substance Abuse Rehabilitation Facility | 717 E Chelten Ave, Philadelphia, PA 19144-1206 | 2017-08-20 |
| 1790213122 | Center City Recovery, LLC | Substance Abuse Rehabilitation Facility | 1880 Jfk Blvd Ste 1110, Philadelphia, PA 19103-7422 | 2017-05-30 |
| 1093267742 | Wanpae | Substance Abuse Rehabilitation Facility | 1622 Catharine St, Philadelphia, PA 19146-2021 | 2016-10-28 |
| 1972958544 | Rittenhouse Health LLC | Substance Abuse Rehabilitation Facility | 2321 N. Broad St, Philadelphia, PA 19132 | 2016-05-02 |
| 1417311150 | Adaptive Care Services | Substance Abuse Rehabilitation Facility | 3524 Wallace St, Philadelphia, PA 19104-1921 | 2016-04-08 |
| 1174901516 | Knesset Klein | Substance Abuse Rehabilitation Facility | 221 E Price St, Philadelphia, PA 19144-2147 | 2015-05-18 |
| 1497020143 | Resources for Human Development, Inc. | Substance Abuse Rehabilitation Facility | 5037 Woodland Ave, Philadelphia, PA 19143 | 2012-03-14 |
| 1760610117 | The King's House | Substance Abuse Rehabilitation Facility | 3509 N American St, Philadelphia, PA 19140-5701 | 2009-06-24 |
| 1558509539 | Joshua Achievment Center | Substance Abuse Rehabilitation Facility | 2016 W Berks St, Philadelphia, PA 19121-2129 | 2009-01-28 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19102 |
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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.