Provider Demographics
NPI:1881114775
Name:PROVIDENCE COMMUNITY PRP INC
Entity type:Organization
Organization Name:PROVIDENCE COMMUNITY PRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-889-0727
Mailing Address - Street 1:416 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3934
Mailing Address - Country:US
Mailing Address - Phone:410-889-0727
Mailing Address - Fax:410-889-0729
Practice Address - Street 1:416 E 30TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3934
Practice Address - Country:US
Practice Address - Phone:410-889-0727
Practice Address - Fax:410-889-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)