Provider Demographics
NPI:1033717707
Name:PROVIDENCE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PROVIDENCE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-951-0713
Mailing Address - Street 1:65 COUNTY ROAD 4782
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-0318
Mailing Address - Country:US
Mailing Address - Phone:903-951-0713
Mailing Address - Fax:
Practice Address - Street 1:1610 POSEY LN STE 200
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4955
Practice Address - Country:US
Practice Address - Phone:903-951-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care