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General NPI Number Information
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NPI Number | 1386273092
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Entity Type | Organization
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Legal Business Name | PROVIDENCE TOTAL CARE LLC
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 10101 HARWIN DR STE 375
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City | HOUSTON
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State | TX
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Zip | 77036-1654
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Country | US
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Telephone | 832-857-8920
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Fax | 832-416-1502
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Provider Business Mailing Address
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Address Line | 10101 HARWIN DR STE 375
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City | HOUSTON
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State | TX
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Zip | 77036-1654
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Country | US
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Telephone | 832-857-8920
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Fax | 832-416-1502
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | OMOTOPE ALEXANDER
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Credential |
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Telephone | 832-857-0892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 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 #3
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #5
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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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