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General NPI Number Information
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NPI Number | 1649834292
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOME CARE
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 5325 VISTA LARGA CIR
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City | RENO
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State | NV
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Zip | 89523-1815
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Country | US
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Telephone | 775-787-1188
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Fax | 775-787-1188
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Provider Business Mailing Address
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Address Line | 1783 FAIRWAY HILLS TRL
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City | RENO
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State | NV
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Zip | 89523-6889
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Country | US
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Telephone | 775-846-2270
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Fax | 775-746-0966
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | MRS. NELIA VALDEZ BUENDIA
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Credential | ADMINISTRATOR
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Telephone | 775-846-2270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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