Provider Demographics
NPI:1710343900
Name:PROVIDIA HOME CARE CORP
Entity Type:Organization
Organization Name:PROVIDIA HOME CARE CORP
Other - Org Name:PREFERRED CARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-425-2670
Mailing Address - Street 1:5292 SUMMERLIN COMMONS WAY
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2163
Mailing Address - Country:US
Mailing Address - Phone:239-425-2670
Mailing Address - Fax:239-425-2671
Practice Address - Street 1:970 LAKE CARILLON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1129
Practice Address - Country:US
Practice Address - Phone:239-425-2670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health