Provider Demographics
NPI:1386045854
Name:PROVISIO HOME CARE LLC
Entity Type:Organization
Organization Name:PROVISIO HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-914-6337
Mailing Address - Street 1:1301 E PARKERVILLE RD
Mailing Address - Street 2:B4
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6420
Mailing Address - Country:US
Mailing Address - Phone:972-737-3044
Mailing Address - Fax:
Practice Address - Street 1:1301 E PARKERVILLE RD
Practice Address - Street 2:B4
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6420
Practice Address - Country:US
Practice Address - Phone:972-737-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care