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General NPI Number Information
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NPI Number | 1497236327
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Entity Type | Organization
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Legal Business Name | PROVIDENCE COMPANION CARE
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 317 HERITAGE DR STE 3B
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-234-0100
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Fax | 662-483-1801
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Provider Business Mailing Address
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Address Line | PO BOX 2047
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City | CLARKSDALE
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State | MS
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Zip | 38614-8047
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Country | US
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Telephone | 662-801-2040
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Fax | 662-483-1801
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROLINE FRAZER
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Credential |
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Telephone | 662-801-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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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 | 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 #3
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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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