Provider Demographics
NPI:1861148942
Name:PROVIDENCE HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:PROVIDENCE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARPUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-703-6760
Mailing Address - Street 1:7426 VINEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2811
Mailing Address - Country:US
Mailing Address - Phone:161-270-3760
Mailing Address - Fax:
Practice Address - Street 1:7426 VINEWOOD LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2811
Practice Address - Country:US
Practice Address - Phone:161-270-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health