Provider Demographics
NPI:1922874932
Name:PRIDE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PRIDE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MBANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-251-9603
Mailing Address - Street 1:14548 FROG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2167
Mailing Address - Country:US
Mailing Address - Phone:857-251-9603
Mailing Address - Fax:
Practice Address - Street 1:14548 FROG LAKE DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2167
Practice Address - Country:US
Practice Address - Phone:857-251-9603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health