Provider Demographics
NPI:1568103919
Name:PROVIDENCE PERSONAL CARE PPC
Entity Type:Organization
Organization Name:PROVIDENCE PERSONAL CARE PPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:DONNA
Authorized Official - Last Name:PROVIDENCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA- RNA
Authorized Official - Phone:424-206-0650
Mailing Address - Street 1:1317 EDGEWATER DR # 4354
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:321-335-4327
Mailing Address - Fax:407-789-3637
Practice Address - Street 1:1317 EDGEWATER DR # 4354
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:321-335-4327
Practice Address - Fax:407-789-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251E00000XAgenciesHome Health