Provider Demographics
NPI:1154629087
Name:PROVIDENCE HOME HEALTH CARE AGENCY,INC.
Entity type:Organization
Organization Name:PROVIDENCE HOME HEALTH CARE AGENCY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING,CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANGE
Authorized Official - Last Name:AUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:516-797-5227
Mailing Address - Street 1:24 DENISE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4319
Mailing Address - Country:US
Mailing Address - Phone:516-797-5227
Mailing Address - Fax:516-797-5227
Practice Address - Street 1:24 DENISE ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4319
Practice Address - Country:US
Practice Address - Phone:516-797-5227
Practice Address - Fax:516-797-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care