Organization
PROVIDENCE HOME HEALTHCARE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROLANDO GUTIERREZ (AGENCY DIRECTOR)
(704) 820-4582
Entity
Organization
Contact information
Practice address
530 E CENTRAL AVE, MOUNT HOLLY, NC 28120-2286
(704) 820-4582
(877) 582-3818
Mailing address
530 E CENTRAL AVE, MOUNT HOLLY, NC 28120-2286
(704) 820-4582
(877) 582-3818
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
HC3882
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HC3882
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
NC
Enumeration date
01/06/2010
Last updated
01/06/2010
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