Provider Demographics
NPI:1114734191
Name:PROVIDENCE IN HOME HEALTH CARE
Entity type:Organization
Organization Name:PROVIDENCE IN HOME HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUKEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-239-8419
Mailing Address - Street 1:884 3RD ST STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4567
Mailing Address - Country:US
Mailing Address - Phone:415-707-5602
Mailing Address - Fax:888-285-5235
Practice Address - Street 1:131A STONY CIR STE 500
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9600
Practice Address - Country:US
Practice Address - Phone:415-707-5602
Practice Address - Fax:888-285-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care