Organization
PROVISION HOME CARE AGENCY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BERTHA GRINTON MITCHELL (OWNER)
(336) 300-9005
Entity
Organization
Contact information
Practice address
3516 VEST MILL RD STE A, WINSTON SALEM, NC 27103-3070
(336) 300-9005
Mailing address
3516 VEST MILL RD STE A, WINSTON SALEM, NC 27103-3070
(336) 300-9005
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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