=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669268991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROVI HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47A BYRNE CT.
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-204-0156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O BOX 4105
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-204-0156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. PATRICK NICANDA ALLALA
-----------------------------------------------------
Credential | ED.D., MBA, MA, CPE
-----------------------------------------------------
Telephone | 330-696-4869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------