Provider Demographics
NPI:1356646053
Name:PROVIDENCE PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIRLIE
Authorized Official - Middle Name:BOLANDO
Authorized Official - Last Name:ARAFILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-6960
Mailing Address - Street 1:2216 E GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3021
Mailing Address - Country:US
Mailing Address - Phone:818-640-6960
Mailing Address - Fax:
Practice Address - Street 1:2216 E GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3021
Practice Address - Country:US
Practice Address - Phone:818-640-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care