Provider Demographics
NPI:1972959641
Name:PROVIDENTIAL LLC
Entity Type:Organization
Organization Name:PROVIDENTIAL LLC
Other - Org Name:SUDBURY RIVER HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-626-1944
Mailing Address - Street 1:1504 CONCORD ST STE B
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7779
Mailing Address - Country:US
Mailing Address - Phone:508-626-1944
Mailing Address - Fax:
Practice Address - Street 1:1504 CONCORD ST STE B
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7779
Practice Address - Country:US
Practice Address - Phone:508-626-1944
Practice Address - Fax:508-626-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health