Healthcare Provider Details

I. General information

NPI: 1154629087
Provider Name (Legal Business Name): PROVIDENCE HOME HEALTH CARE AGENCY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DENISE ST
MASSAPEQUA NY
11758-4319
US

IV. Provider business mailing address

24 DENISE ST
MASSAPEQUA NY
11758-4319
US

V. Phone/Fax

Practice location:
  • Phone: 516-797-5227
  • Fax: 516-797-5227
Mailing address:
  • Phone: 516-797-5227
  • Fax: 516-797-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIE ANGE AUPONT
Title or Position: DIRECTOR OF NURSING,CEO
Credential: RN
Phone: 516-797-5227