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General NPI Number Information
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NPI Number | 1922611011
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOME CARE INC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 2805 CLIFF RD E STE 200B
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City | BURNSVILLE
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State | MN
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Zip | 55337-4095
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Country | US
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Telephone | 612-978-2108
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Fax | 612-486-9109
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Provider Business Mailing Address
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Address Line | PO BOX 22304
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City | SAINT PAUL
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State | MN
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Zip | 55122-0304
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Country | US
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Telephone | 612-978-2108
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Fax | 612-486-9109
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Authorized Official
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Title or Position | OWNER
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Name | FAHIMA MOHAMED ABDI
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Credential |
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Telephone | 612-978-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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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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