Provider Demographics
NPI:1912249624
Name:PROVIDE HOMECARE INC
Entity Type:Organization
Organization Name:PROVIDE HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIVEHCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:714-283-2085
Mailing Address - Street 1:5753G E SANTA ANA CANYON RD # 245
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3229
Mailing Address - Country:US
Mailing Address - Phone:714-283-2085
Mailing Address - Fax:714-283-2230
Practice Address - Street 1:5419 E ESTATE RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4662
Practice Address - Country:US
Practice Address - Phone:714-283-2085
Practice Address - Fax:714-283-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3320910251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health