Provider Demographics
NPI:1861272452
Name:PROVIDENT HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:PROVIDENT HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:KWAME
Authorized Official - Last Name:ASAMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-328-7530
Mailing Address - Street 1:2651 APEX CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5030
Mailing Address - Country:US
Mailing Address - Phone:513-328-7530
Mailing Address - Fax:
Practice Address - Street 1:2651 APEX CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-5030
Practice Address - Country:US
Practice Address - Phone:513-328-7530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health