| NPI | 1780819003 |
|---|---|
| Doing Business As | PROVISIONS COMMUNITY SUPPORT SERVICES, LLC |
| Entity Type | Organization |
| Authorized Contact | JANNETTA DELOIS JORDAN CEO 910-308-8366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2009-05-17 |
| Last Update Date | 2009-07-07 |