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General NPI Number Information
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NPI Number | 1649630732
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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 | 03/02/2016
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 2400 E BUSINESS LOOP 70
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City | COLUMBIA
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State | MO
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Zip | 65201-5510
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Country | US
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Telephone | 573-442-5950
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Fax | 573-442-5386
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Provider Business Mailing Address
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Address Line | 2400 E BUSINESS LOOP 70
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City | COLUMBIA
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State | MO
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Zip | 65201-5510
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Country | US
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Telephone | 573-442-5950
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Fax | 573-442-5386
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. MOHAMED ELKOMY
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Credential |
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Telephone | 573-442-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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