Provider Demographics
NPI:1144864463
Name:PROVIDENTIAL CARES, LLC
Entity type:Organization
Organization Name:PROVIDENTIAL CARES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:434-574-2247
Mailing Address - Street 1:281 ELAM RD
Mailing Address - Street 2:
Mailing Address - City:PAMPLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23958-3242
Mailing Address - Country:US
Mailing Address - Phone:434-574-2247
Mailing Address - Fax:434-574-2028
Practice Address - Street 1:281 ELAM RD
Practice Address - Street 2:
Practice Address - City:PAMPLIN
Practice Address - State:VA
Practice Address - Zip Code:23958-3242
Practice Address - Country:US
Practice Address - Phone:434-574-2247
Practice Address - Fax:434-574-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)