Provider Demographics
NPI:1831662022
Name:PROVIDENT HOME CARE, INC.
Entity Type:Organization
Organization Name:PROVIDENT HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:615-347-0900
Mailing Address - Street 1:123 PEBBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5525
Mailing Address - Country:US
Mailing Address - Phone:615-347-0900
Mailing Address - Fax:
Practice Address - Street 1:4934 17TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5202
Practice Address - Country:US
Practice Address - Phone:615-347-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health