Provider Demographics
NPI:1225841968
Name:PROVIDENCE SUPPORT SERVICES
Entity type:Organization
Organization Name:PROVIDENCE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:732-322-3924
Mailing Address - Street 1:3 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4737
Mailing Address - Country:US
Mailing Address - Phone:732-322-3924
Mailing Address - Fax:267-841-7275
Practice Address - Street 1:3 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-4737
Practice Address - Country:US
Practice Address - Phone:732-322-3924
Practice Address - Fax:267-841-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care