Provider Demographics
NPI:1649834292
Name:PROVIDENCE HOME CARE
Entity type:Organization
Organization Name:PROVIDENCE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:VALDEZ
Authorized Official - Last Name:BUENDIA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:775-846-2270
Mailing Address - Street 1:1783 FAIRWAY HILLS TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-6889
Mailing Address - Country:US
Mailing Address - Phone:775-846-2270
Mailing Address - Fax:775-746-0966
Practice Address - Street 1:5325 VISTA LARGA CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1815
Practice Address - Country:US
Practice Address - Phone:775-787-1188
Practice Address - Fax:775-787-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home