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General NPI Number Information
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NPI Number | 1609576057
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOME CARE LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 3350 RIVERWOOD PKWY SE STE 1900
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City | ATLANTA
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State | GA
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Zip | 30339-2066
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Country | US
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Telephone | 770-430-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 1992 KIMBERLY VILLAGE LN SE APT F
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City | MARIETTA
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State | GA
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Zip | 30067-8499
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Country | US
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Telephone | 770-430-2988
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MERCY NGANGA
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Credential | RN
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Telephone | 770-430-2988
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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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