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General NPI Number Information
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NPI Number | 1104847946
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Entity Type | Organization
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Legal Business Name | THE PROVIDENCE CENTER INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 530 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5762
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Country | US
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Telephone | 401-528-0123
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Fax | 401-528-0124
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Provider Business Mailing Address
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Address Line | 528 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-5757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PAYER CREDENTIALING SPECIALIST
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Name | CARLA SOSA
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Credential |
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Telephone | 401-921-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207SG0205X
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Taxonomy Name | Ph.D. Medical Genetics Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 631
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License Number State | RI
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Taxonomy #9
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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