# PROVIDENT HOME CARE, INC.

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

## Provider details

- **NPI number:** 1962123513
- **Authorized official:** MR. DAVID E WILSON CPA (OWNER/CFO)
- **Authorized official phone:** (615) 347-0900

## Contact information

- **Practice address:** 925 S CHURCH ST STE B200, MURFREESBORO, TN 37130-4993
- **Practice address phone:** (615) 962-7217
- **Practice address fax:** (615) 962-7298
- **Mailing address:** 1515 S ATLANTIC AVE APT 204, COCOA BEACH, FL 32931-2374
- **Mailing address phone:** (615) 347-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 09/12/2022
- **Last updated:** 08/09/2024