Organization
PROVISION HOME HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGENA WILEY (ADMINISTRATOR)
(708) 335-3689
Entity
Organization
Contact information
Practice address
17065 DIXIE HWY STE 36, HAZEL CREST, IL 60429-1384
(708) 335-3689
Mailing address
17065 DIXIE HWY STE 36, HAZEL CREST, IL 60429-1384
(708) 335-3689
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/21/2008
Last updated
02/21/2008
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