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General NPI Number Information
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NPI Number | 1598150526
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Entity Type | Organization
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Legal Business Name | PROVIDIA HOME CARE LLC
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 915 YANCEY CT SUITE 105
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City | LOGANVILLE
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State | GA
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Zip | 30052-9037
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Country | US
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Telephone | 404-406-2514
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Fax |
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Provider Business Mailing Address
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Address Line | 915 YANCEY CT SUITE 105
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City | LOGANVILLE
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State | GA
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Zip | 30052-9037
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Country | US
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Telephone | 404-406-2514
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Fax |
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Authorized Official
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Title or Position | ADMNISTRATOR
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Name | MISS TOVA NIEVES
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Credential |
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Telephone | 404-406-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 075-R-0965
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 075-R-0965
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License Number State | GA
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