Provider Demographics
NPI:1427284397
Name:HISPROVIDENCE HOME HEALTH CARE,LLC
Entity type:Organization
Organization Name:HISPROVIDENCE HOME HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PROVIDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:540-878-5746
Mailing Address - Street 1:6803 MILL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-9204
Mailing Address - Country:US
Mailing Address - Phone:540-878-5746
Mailing Address - Fax:540-878-5746
Practice Address - Street 1:6803 MILL VALLEY DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-9204
Practice Address - Country:US
Practice Address - Phone:540-878-5746
Practice Address - Fax:540-878-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09563251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health