Healthcare Provider Details

I. General information

NPI: 1760023998
Provider Name (Legal Business Name): PROVIDENTIAL HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E RIO RD STE 201C
CHARLOTTESVILLE VA
22901-1751
US

IV. Provider business mailing address

1445 E RIO RD STE 201C
CHARLOTTESVILLE VA
22901-1751
US

V. Phone/Fax

Practice location:
  • Phone: 978-844-6486
  • Fax:
Mailing address:
  • Phone: 978-844-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIANA AMEYAA SARPONG
Title or Position: DIRECTOR AND ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 978-844-6486