MEDICARE: PROVIDIA HOME CARE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	299993041	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245409010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDIA HOME CARE LLC.

Provider Business Mailing Address
First Line	:	5292 SUMMERLIN COMMONS WAY STE 1102
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2163
Country	:	US
Telephone Number	:	239-425-2670
Fax Number	:	239-425-2671

Provider Business Practice Location Address
First Line	:	5292 SUMMERLIN COMMONS WAY STE 1102
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2163
Country	:	US
Telephone Number	:	239-425-2670
Fax Number	:	239-425-2671

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER ANDREW MELLEY
Credential	:
Telephone Number	:	239-425-2670

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	09/05/2025

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Directions to “PROVIDIA HOME CARE LLC. ” Practice Location

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