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Organization
PROVIDENT HOME HEALTH, INC.
Active
Organization
PROVIDENT HOME HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORA GONZAGA (OWNER/CEO)
(818) 241-9500
Entity
Organization
Contact information
Practice address
5015 EAGLE ROCK BLVD STE 309A, LOS ANGELES, CA 90041-2085
(818) 241-9500
(818) 241-9509
Mailing address
5015 EAGLE ROCK BLVD STE 309A, LOS ANGELES, CA 90041-2085
(818) 241-9500
(818) 241-9509
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
980001477
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HHA08286F
—
CA
Enumeration date
12/05/2006
Last updated
05/14/2021
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