| NPI | 1376625137 |
|---|---|
| Doing Business As | PROVIDENCE CHILD CENTER |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Sec Enrollmt/Dir Reimb Reg 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: OR 1700250565) |
| Additional Taxonomies | 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric (Licence: OR 1035453259) |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child (Licence: OR 1035453259) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2019-08-28 |