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	251J00000X	Nursing Care Agency	075-R-0965	GA
2	253Z00000X	In Home Supportive Care Agency	075-R-0965	GA

General Provider Information

NPI Number	:	1598150526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDIA HOME CARE LLC

Provider Business Mailing Address
First Line	:	915 YANCEY CT
Second Line	:	SUITE 105
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9037
Country	:	US
Telephone Number	:	404-406-2514
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 YANCEY CT
Second Line	:	SUITE 105
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9037
Country	:	US
Telephone Number	:	404-406-2514
Fax Number	:

Authorized Official
Title or Position	:	ADMNISTRATOR
Name	:	MISS TOVA NIEVES
Credential	:
Telephone Number	:	404-406-2514

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/06/2015

Similar Medicare Providers

1578426979 — AIDE PLUS HOMECARE SERVICES LLC
Practice Location Address:

903 YANCEY CT
LOGANVILLE, GA
30052-9037

Practice Phone: 470-504-0979
Practice Fax:

1992347017 — MS. BERNADETTE WARNER
Practice Location Address:

919 YANCEY CT
LOGANVILLE, GA
30052-9037

Practice Phone: 678-296-8741
Practice Fax:

1275359655 — SIMPLY SMILE P.S.C.
Practice Location Address:

3920 POINTER RD
LOGANVILLE, GA
30052-2889

Practice Phone: 404-313-0944
Practice Fax:

1992381776 — CATHERINE GRAYSON BCBA
Practice Location Address:

2615 SANDY CREEK CIR
LOGANVILLE, GA
30052-3008

Practice Phone: 770-925-5551
Practice Fax:

1649720079 — DR. YAHAZIEL SIMON D.M.D.
Practice Location Address:

4763 ATLANTA HWY STE 380
LOGANVILLE, GA
30052-6793

Practice Phone: 770-962-9560
Practice Fax:

1487518544 — CAREY CAMPBELL MATHURIN
Practice Location Address:

3540 HWY 78 SUITE 103
LOGANVILLE, GA
30052

Practice Phone: 470-375-2196
Practice Fax:

Directions to “PROVIDIA HOME CARE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.