Provider Demographics
NPI:1114770534
Name:PROVIDENCE RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRASSER-NICOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-817-6560
Mailing Address - Street 1:4315 50TH ST NW STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4369
Mailing Address - Country:US
Mailing Address - Phone:202-644-2245
Mailing Address - Fax:
Practice Address - Street 1:4315 50TH ST NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4369
Practice Address - Country:US
Practice Address - Phone:202-644-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care