Provider Demographics
NPI:1811307432
Name:PROVIDENCE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PROVIDENCE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-736-1280
Mailing Address - Street 1:5100 N SIXTH ST
Mailing Address - Street 2:118
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5100 N 6TH ST
Practice Address - Street 2:118
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7514
Practice Address - Country:US
Practice Address - Phone:818-736-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health