Provider Demographics
NPI:1487272324
Name:PROVIDENCE HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:PROVIDENCE HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KETHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-254-7099
Mailing Address - Street 1:1230 PEACHTREE ST NE FL 19
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3574
Mailing Address - Country:US
Mailing Address - Phone:404-254-7099
Mailing Address - Fax:678-658-7634
Practice Address - Street 1:1230 PEACHTREE ST NE FL 19
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3574
Practice Address - Country:US
Practice Address - Phone:404-254-7099
Practice Address - Fax:678-658-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health