Provider Demographics
NPI:1649630732
Name:PROVIDENCE HOME CARE LLC
Entity type:Organization
Organization Name:PROVIDENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKOMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-442-5950
Mailing Address - Street 1:2400 E BUSINESS LOOP 70
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5510
Mailing Address - Country:US
Mailing Address - Phone:573-442-5950
Mailing Address - Fax:573-442-5386
Practice Address - Street 1:2400 E BUSINESS LOOP 70
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5510
Practice Address - Country:US
Practice Address - Phone:573-442-5950
Practice Address - Fax:573-442-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health