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Organization

PROVIDENCE NURSING SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JACK G WATKINS JR. RN. (OWNER/MANAGER)
(208) 413-3312
Entity
Organization

Contact information

Practice address
1008 W HONKER DR, MERIDIAN, ID 83642-7735
(208) 413-3312
(208) 209-5123
Mailing address
1008 W HONKER DR, MERIDIAN, ID 83642-7735
(208) 413-3312
(208) 209-5123

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
603069327
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
615764900
DOL CARE PROVIDER NUMBER.
ID
Enumeration date
03/22/2011
Last updated
03/22/2011
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