Organization · NPI-2

The Providencia Group

Case Manager/Care Coordinator · Ashburn, VA

NPI number1972362796
StatusActive
Last updated in NPPESMar 14, 2024

Details

NPI
1972362796
Entity type
Organization (NPI-2)
Legal business name
The Providencia Group
Organization subpart
No
Enumeration date
Mar 14, 2024
Certification date
Mar 14, 2024
Last updated
Mar 14, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171M00000X Case Manager/Care Coordinator––Yes

Practice location

19775 Belmont Executive Plz Ste 450
Ashburn, VA 20147-7606

Phone 571-431-1458

Mailing address

7773 Waikapu Loop
Honolulu, HI 96825-3026

Phone 808-282-1840

Authorized official

Kevin Marquez
Ceo
5712234629

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