Provider Demographics
NPI:1174031942
Name:PROVIDENCE HOMECARE PROVIDERS PLLC
Entity Type:Organization
Organization Name:PROVIDENCE HOMECARE PROVIDERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINA
Authorized Official - Middle Name:CABUENA
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-260-3137
Mailing Address - Street 1:25511 SOUTHFIELD RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1830
Mailing Address - Country:US
Mailing Address - Phone:248-443-6690
Mailing Address - Fax:248-443-6692
Practice Address - Street 1:25511 SOUTHFIELD RD STE 118
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1830
Practice Address - Country:US
Practice Address - Phone:248-443-6690
Practice Address - Fax:248-443-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty