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General NPI Number Information
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NPI Number | 1649136201
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Entity Type | Organization
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Legal Business Name | PROVIDENTIAL HEALTHCARE LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 2840 MACK RD
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City | FAIRFIELD
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State | OH
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Zip | 45014-5130
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Country | US
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Telephone | 513-365-0882
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 MACK RD
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City | FAIRFIELD
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State | OH
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Zip | 45014-5130
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Country | US
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Telephone | 513-365-0882
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | EUGENIA MARY TWUMWAA
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Credential | RN
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Telephone | 513-365-0882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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