Provider Demographics
NPI:1235455239
Name:PROVIDENTIAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:PROVIDENTIAL HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:MWESIGWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-240-6146
Mailing Address - Street 1:13400 SUTTON PARK DR S
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0236
Mailing Address - Country:US
Mailing Address - Phone:904-992-2273
Mailing Address - Fax:904-992-2270
Practice Address - Street 1:13400 SUTTON PARK DR S
Practice Address - Street 2:SUITE 1101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0236
Practice Address - Country:US
Practice Address - Phone:904-992-2273
Practice Address - Fax:904-992-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care