Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Rehabilitation, Substance Use Disorder |
261QR0405X | |||
Addiction (Substance Use Disorder) |
101YA0400X | |||
Adult Mental Health |
261QM0850X | |||
Mental Health |
101YM0800X | |||
Substance Abuse Disorder Rehabilitation Facility |
324500000X |
| NPI Number | 1730562711 |
||||
| LBN Legal business name | PROVIDENCE LIVING TREATMENT CENTER | ||||
| Authorized official | WILLIAM HERAN - (CEO) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 07/08/2015 | ||||
| Last updated | 08/25/2025 - About 10 months ago | ||||
| Identifiers |
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