Provider Demographics
NPI:1396163515
Name:PROVISION CARE SERVICES, LLC
Entity type:Organization
Organization Name:PROVISION CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:646-554-7958
Mailing Address - Street 1:786 BRONX RIVER RD
Mailing Address - Street 2:#B62
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-7952
Mailing Address - Country:US
Mailing Address - Phone:718-644-7159
Mailing Address - Fax:
Practice Address - Street 1:4653 WHITE PLAINS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1635
Practice Address - Country:US
Practice Address - Phone:718-644-7159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584420251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management