Provider Demographics
NPI:1558508648
Name:PROVIDENT HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROVIDENT HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-530-0442
Mailing Address - Street 1:7950 SILVERTON AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6342
Mailing Address - Country:US
Mailing Address - Phone:858-530-0442
Mailing Address - Fax:858-530-0545
Practice Address - Street 1:7950 SILVERTON AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6342
Practice Address - Country:US
Practice Address - Phone:858-530-0442
Practice Address - Fax:858-530-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175530163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty