# PROVIDIA HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598150526
- **Authorized official:** MISS TOVA NIEVES (ADMNISTRATOR)
- **Authorized official phone:** (404) 406-2514

## Contact information

- **Practice address:** 915 YANCEY CT, SUITE 105, LOGANVILLE, GA 30052-9037
- **Practice address phone:** (404) 406-2514
- **Mailing address:** 915 YANCEY CT, SUITE 105, LOGANVILLE, GA 30052-9037
- **Mailing address phone:** (404) 406-2514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251J00000X | Nursing Care Agency | 075-R-0965 | GA | — |
| 253Z00000X | In Home Supportive Care Agency | 075-R-0965 | GA | Yes |

## Other

- **Enumeration date:** 04/06/2015
- **Last updated:** 04/06/2015