| Providence House | |
|
8037 Unruh Dr Georgetown IN 47122-8759 | |
| (812) 951-1878 | |
| (812) 951-0398 |
| Full Name | Providence House |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 8037 Unruh Dr, Georgetown, Indiana |
| Authorized Official Name and Position | Elizabeth Porter England (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5022240789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence House 8037 Unruh Dr Georgetown IN 47122-8759 Ph: (812) 951-1878 | Providence House 8037 Unruh Dr Georgetown IN 47122-8759 Ph: (812) 951-1878 |
| NPI Number | 1477603538 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 08/22/2024 |
| Certification Date | 08/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477603538 | NPI | - | NPPES |
| 200358070 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
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