Provider Demographics
NPI:1790081545
Name:PROVIDENCE PERSONAL ASSISTANCE SERVICES INC.
Entity Type:Organization
Organization Name:PROVIDENCE PERSONAL ASSISTANCE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-226-8759
Mailing Address - Street 1:6701 VICTORY CREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3672
Mailing Address - Country:US
Mailing Address - Phone:817-226-8759
Mailing Address - Fax:817-226-8759
Practice Address - Street 1:6701 VICTORY CREST DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3672
Practice Address - Country:US
Practice Address - Phone:817-226-8759
Practice Address - Fax:817-226-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00226251E00000X
TX08812253Z00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty