Provider Demographics
NPI:1922883156
Name:FAMILY PROVIDENCE HOME CARE LLC
Entity Type:Organization
Organization Name:FAMILY PROVIDENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-250-1758
Mailing Address - Street 1:146 MLK JR BLVD # 253
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5620
Mailing Address - Country:US
Mailing Address - Phone:770-250-1758
Mailing Address - Fax:
Practice Address - Street 1:2744 POWELL CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-8675
Practice Address - Country:US
Practice Address - Phone:770-250-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care