Provider Demographics
NPI:1104792720
Name:PROVISION HOME CARE, LLC
Entity type:Organization
Organization Name:PROVISION HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:MERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-618-7053
Mailing Address - Street 1:1051 COUNTY STREET 2983
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-4445
Mailing Address - Country:US
Mailing Address - Phone:405-618-7053
Mailing Address - Fax:
Practice Address - Street 1:1051 COUNTY STREET 2983
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-4445
Practice Address - Country:US
Practice Address - Phone:405-618-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health