Provider Demographics
NPI:1619283249
Name:PROVIDENCE HEALTH CARE STAFFING, INC.
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH CARE STAFFING, INC.
Other - Org Name:PROVIDENCE SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SITES-BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-472-3810
Mailing Address - Street 1:1040 RANDOLPH ST STE 42
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6384
Mailing Address - Country:US
Mailing Address - Phone:336-472-3810
Mailing Address - Fax:336-472-3811
Practice Address - Street 1:1040 RANDOLPH ST STE 42
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6384
Practice Address - Country:US
Practice Address - Phone:336-472-3810
Practice Address - Fax:336-472-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4146251C00000X, 251G00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based