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General NPI Number Information
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NPI Number | 1255449922
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Entity Type | Organization
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Legal Business Name | PROVISION HOMECARE, LLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 124 MAIN ST E
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City | AHOSKIE
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State | NC
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Zip | 27910-3416
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Country | US
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Telephone | 252-332-4409
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Fax | 252-332-5099
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Provider Business Mailing Address
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Address Line | 124 MAIN ST E
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City | AHOSKIE
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State | NC
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Zip | 27910-3416
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Country | US
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Telephone | 252-332-4409
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Fax | 252-332-5099
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Authorized Official
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Title or Position | DIRECTOR CEO
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Name | PHYLLISTINE E SIMMONS
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Credential |
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Telephone | 252-287-3562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC2981
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License Number State | NC
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