Organization
PROVIDIA HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TOVA NIEVES (ADMNISTRATOR)
(404) 406-2514
Entity
Organization
Contact information
Practice address
915 YANCEY CT, SUITE 105, LOGANVILLE, GA 30052-9037
(404) 406-2514
Mailing address
915 YANCEY CT, SUITE 105, LOGANVILLE, GA 30052-9037
(404) 406-2514
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
075-R-0965
GA
253Z00000X
In Home Supportive Care Agency
Primary
075-R-0965
GA
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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