Provider Demographics
NPI:1376829697
Name:PROVIDENCE HOME MEDICAL, L.P.
Entity type:Organization
Organization Name:PROVIDENCE HOME MEDICAL, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-770-5689
Mailing Address - Street 1:451 VALLEY BROOK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3375
Mailing Address - Country:US
Mailing Address - Phone:866-854-7436
Mailing Address - Fax:866-876-9841
Practice Address - Street 1:451 VALLEY BOOK ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3375
Practice Address - Country:US
Practice Address - Phone:866-854-7436
Practice Address - Fax:866-876-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies