MEDICARE: PROVIDENCE HOME CARE INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518739044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HOME CARE INC.

Provider Business Mailing Address
First Line	:	1534 NICHOLS RD
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-3616
Country	:	US
Telephone Number	:	540-589-2291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 NICHOLS RD
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-3616
Country	:	US
Telephone Number	:	540-589-2291
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MICHAEL BURNS
Credential	:
Telephone Number	:	540-589-2291

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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