Provider Demographics
NPI:1689330417
Name:PROV16, LLC
Entity Type:Organization
Organization Name:PROV16, LLC
Other - Org Name:A BETTER SOLUTION IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONTRACT PROCUREMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-588-7873
Mailing Address - Street 1:1111 S ORCHARD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1922
Mailing Address - Country:US
Mailing Address - Phone:208-285-2353
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1922
Practice Address - Country:US
Practice Address - Phone:208-285-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1689330417OtherNPI