Provider Demographics
NPI:1235615444
Name:PROVIDENCE STAFFING GROUP LLC
Entity Type:Organization
Organization Name:PROVIDENCE STAFFING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRESELECT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-532-8770
Mailing Address - Street 1:104 INDUSTRIAL BLVD STE J-1
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3180
Mailing Address - Country:US
Mailing Address - Phone:832-532-8770
Mailing Address - Fax:713-583-3337
Practice Address - Street 1:104 INDUSTRIAL BLVD STE J-1
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3180
Practice Address - Country:US
Practice Address - Phone:832-532-8770
Practice Address - Fax:713-583-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health