Provider Demographics
NPI:1760023998
Name:PROVIDENTIAL HOMECARE
Entity Type:Organization
Organization Name:PROVIDENTIAL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:AMEYAA
Authorized Official - Last Name:SARPONG
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:978-844-6486
Mailing Address - Street 1:1445 E RIO RD STE 201C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1751
Mailing Address - Country:US
Mailing Address - Phone:978-844-6486
Mailing Address - Fax:
Practice Address - Street 1:1445 E RIO RD STE 201C
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1751
Practice Address - Country:US
Practice Address - Phone:978-844-6486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care