Provider Demographics
NPI:1598150526
Name:PROVIDIA HOME CARE LLC
Entity Type:Organization
Organization Name:PROVIDIA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TOVA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-406-2514
Mailing Address - Street 1:915 YANCEY CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9037
Mailing Address - Country:US
Mailing Address - Phone:404-406-2514
Mailing Address - Fax:
Practice Address - Street 1:915 YANCEY CT
Practice Address - Street 2:SUITE 105
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9037
Practice Address - Country:US
Practice Address - Phone:404-406-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0965251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care