Provider Demographics
NPI:1114951043
Name:PROVIDENT MEDICAL EQUIPMENTS AND HOME CARE, INC.
Entity Type:Organization
Organization Name:PROVIDENT MEDICAL EQUIPMENTS AND HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COSMAS
Authorized Official - Middle Name:ONWUDIWE
Authorized Official - Last Name:ONUORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-649-9100
Mailing Address - Street 1:4763 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2551
Mailing Address - Country:US
Mailing Address - Phone:330-649-9100
Mailing Address - Fax:330-649-9101
Practice Address - Street 1:4763 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2551
Practice Address - Country:US
Practice Address - Phone:330-649-9100
Practice Address - Fax:330-649-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1568045332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies