# PROVIDENTIAL HOME CARE OF NWA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providential Home Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104416247
- **Authorized official:** MR. MARK KERSEY (OWNER)
- **Authorized official phone:** (479) 668-4338

## Contact information

- **Practice address:** 113 PARKWOOD ST STE B, LOWELL, AR 72745-8811
- **Practice address phone:** (479) 668-4338
- **Practice address fax:** (888) 247-6285
- **Mailing address:** 113 PARKWOOD ST STE B, LOWELL, AR 72745-8811
- **Mailing address phone:** (479) 668-4338
- **Mailing address fax:** (888) 247-6285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2021
- **Last updated:** 01/22/2021