Provider Demographics
NPI:1013085075
Name:PROVIDENCE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:1714-221-6400
Mailing Address - Street 1:1246 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1344
Mailing Address - Country:US
Mailing Address - Phone:714-745-0619
Mailing Address - Fax:
Practice Address - Street 1:1246 OAK ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-1344
Practice Address - Country:US
Practice Address - Phone:714-745-0619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management