Organization
PROVIDENTIAL HOME CARE OF NWA LLC
Active
Other names
Providential Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK KERSEY (OWNER)
(479) 668-4338
Entity
Organization
Contact information
Practice address
113 PARKWOOD ST STE B, LOWELL, AR 72745-8811
(479) 668-4338
(888) 247-6285
Mailing address
113 PARKWOOD ST STE B, LOWELL, AR 72745-8811
(479) 668-4338
(888) 247-6285
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234403732
—
AR
Enumeration date
01/22/2021
Last updated
01/22/2021
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