Healthcare Provider Details

I. General information

NPI: 1407713340
Provider Name (Legal Business Name): PROVIDENCE WELLNESS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 BROOKE GROVE RD
BOWIE MD
20721-1887
US

IV. Provider business mailing address

2610 BROOKE GROVE RD
BOWIE MD
20721-1887
US

V. Phone/Fax

Practice location:
  • Phone: 301-532-3085
  • Fax:
Mailing address:
  • Phone: 301-532-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS GODSON
Title or Position: PRESIDENT
Credential:
Phone: 301-532-3085