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General NPI Number Information
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NPI Number | 1225841968
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SUPPORT SERVICES
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3 RIDGEWOOD DR
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City | BORDENTOWN
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State | NJ
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Zip | 08505-4737
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Country | US
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Telephone | 732-322-3924
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Fax | 267-841-7275
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Provider Business Mailing Address
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Address Line | 3 RIDGEWOOD DR
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City | BORDENTOWN
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State | NJ
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Zip | 08505-4737
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Country | US
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Telephone | 732-322-3924
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Fax | 267-841-7275
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HENRY O ADEBAYO
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Credential | N/A
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Telephone | 732-322-3924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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