MEDICARE: PROVISIONS HHS, 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	251E00000X	Home Health Agency

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	:	1639408453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVISIONS HHS, INC

Provider Business Mailing Address
First Line	:	1027 S RAINBOW BLVD
Second Line	:	#207
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-428-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 S RAINBOW BLVD
Second Line	:	#207
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-428-3726
Fax Number	:

Authorized Official
Title or Position	:	CEO/ FOUNDER
Name	:	MISS OLIVIA PATRICE PETTWAY
Credential	:
Telephone Number	:	702-428-3726

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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