Provider Demographics
NPI:1215218920
Name:PROVIDENCE HOME CARE AGENCY INC.
Entity Type:Organization
Organization Name:PROVIDENCE HOME CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-421-8623
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-0464
Mailing Address - Country:US
Mailing Address - Phone:610-421-8623
Mailing Address - Fax:610-965-1313
Practice Address - Street 1:222 MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2749
Practice Address - Country:US
Practice Address - Phone:610-421-8623
Practice Address - Fax:610-965-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21583601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health