Provider Demographics
NPI:1558649277
Name:PROVIDENCE NURSING SERVICES INC.
Entity Type:Organization
Organization Name:PROVIDENCE NURSING SERVICES INC.
Other - Org Name:COMMUNITY CAREGIVERS OF GREEN NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-899-0048
Mailing Address - Street 1:4684 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1137
Mailing Address - Country:US
Mailing Address - Phone:330-899-0048
Mailing Address - Fax:330-899-9780
Practice Address - Street 1:4684 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1137
Practice Address - Country:US
Practice Address - Phone:330-899-0048
Practice Address - Fax:330-899-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health