Provider Demographics
NPI:1245409010
Name:PROVIDIA HOME CARE LLC.
Entity Type:Organization
Organization Name:PROVIDIA HOME CARE LLC.
Other - Org Name:PREFERRED CARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-425-2670
Mailing Address - Street 1:5292 SUMMERLIN COMMONS WAY
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2163
Mailing Address - Country:US
Mailing Address - Phone:239-425-2670
Mailing Address - Fax:239-425-2671
Practice Address - Street 1:5292 SUMMERLIN COMMONS WAY
Practice Address - Street 2:SUITE 1102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2163
Practice Address - Country:US
Practice Address - Phone:239-425-2670
Practice Address - Fax:239-425-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993041251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
109423Medicare Oscar/Certification