Provider Demographics
NPI:1487613071
Name:PROVIDENCE HOMECARE SERVICES, LLC
Entity type:Organization
Organization Name:PROVIDENCE HOMECARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PRIVACY&SAFETY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-4373
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:903-537-8656
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:200 RIVER POINTE DR STE 110A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2814
Practice Address - Country:US
Practice Address - Phone:936-539-9846
Practice Address - Fax:936-539-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009364251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457882Medicare Oscar/Certification