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Organization
PROVISION HOMECARE, LLC
Active
Organization
PROVISION HOMECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLISTINE E SIMMONS (DIRECTOR CEO)
(252) 287-3562
Entity
Organization
Contact information
Practice address
124 MAIN ST E, AHOSKIE, NC 27910-3416
(252) 332-4409
(252) 332-5099
Mailing address
124 MAIN ST E, AHOSKIE, NC 27910-3416
(252) 332-4409
(252) 332-5099
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HC2981
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3408323
CAPS
NC
05
—
6601267
—
NC
01
—
8301311
COMMUNITY SUPPORT
NC
Enumeration date
08/25/2006
Last updated
06/25/2025
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