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General NPI Number Information
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NPI Number | 1114734191
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Entity Type | Organization
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Legal Business Name | PROVIDENCE IN HOME HEALTH CARE
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 131A STONY CIR STE 500
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City | SANTA ROSA
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State | CA
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Zip | 95401-9600
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Country | US
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Telephone | 415-707-5602
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Fax | 888-285-5235
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Provider Business Mailing Address
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Address Line | 884 3RD ST STE D
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City | SANTA ROSA
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State | CA
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Zip | 95404-4567
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Country | US
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Telephone | 415-707-5602
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Fax | 888-285-5235
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PITA TAUKEI
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Credential |
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Telephone | 707-239-8419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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