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General NPI Number Information
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NPI Number | 1619283249
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH CARE STAFFING, INC.
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1040 RANDOLPH ST STE 42
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City | THOMASVILLE
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State | NC
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Zip | 27360-6384
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Country | US
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Telephone | 336-472-3810
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Fax | 336-472-3811
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Provider Business Mailing Address
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Address Line | 1040 RANDOLPH ST STE 42
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City | THOMASVILLE
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State | NC
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Zip | 27360-6384
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Country | US
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Telephone | 336-472-3810
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Fax | 336-472-3811
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE ANN SITES-BRYAN
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Credential |
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Telephone | 336-472-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | HC4146
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | HC4146
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License Number State | NC
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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 | HC4146
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License Number State | NC
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