Provider Demographics
NPI:1952121832
Name:PROVOBIS LLC
Entity type:Organization
Organization Name:PROVOBIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKEZIELAMNANWA
Authorized Official - Middle Name:JOE OKEY
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-600-6309
Mailing Address - Street 1:535 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1128
Mailing Address - Country:US
Mailing Address - Phone:612-600-6309
Mailing Address - Fax:
Practice Address - Street 1:535 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1128
Practice Address - Country:US
Practice Address - Phone:612-600-6309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health