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General NPI Number Information
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NPI Number | 1275938912
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOMECARE SERVICES INC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 6965 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60645-4710
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Country | US
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Telephone | 773-274-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 6965 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60645-4710
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Country | US
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Telephone | 773-274-3627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILSON ATIABET
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Credential |
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Telephone | 773-274-3627
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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 |
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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