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General NPI Number Information
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NPI Number | 1427284397
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Entity Type | Organization
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Legal Business Name | HISPROVIDENCE HOME HEALTH CARE,LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 6803 MILL VALLEY DR
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City | WARRENTON
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State | VA
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Zip | 20187-9204
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Country | US
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Telephone | 540-878-5746
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Fax | 540-878-5746
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Provider Business Mailing Address
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Address Line | 6803 MILL VALLEY DR
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City | WARRENTON
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State | VA
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Zip | 20187-9204
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Country | US
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Telephone | 540-878-5746
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Fax | 540-878-5746
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | MR. PROVIDENCE SEY
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Credential | RN, BSN
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Telephone | 540-878-5746
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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 | HCO-09563
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License Number State | VA
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