| NPI | 1487755922 |
|---|---|
| Other Name | PROVIDENCE HOUSE |
| Entity Type | Organization |
| Authorized Contact | DAVID RANDOLPH GRAHAM Dir Of Accounting & Administration 804-864-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: VA 295-14-006) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-09-24 |