Provider Demographics
NPI:1750730586
Name:PROVISIONS HOME HEALTHCARE SERVICES,LLC
Entity type:Organization
Organization Name:PROVISIONS HOME HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERISSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:215-399-9766
Mailing Address - Street 1:10067 SANDMEYER LN
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3533
Mailing Address - Country:US
Mailing Address - Phone:215-399-9766
Mailing Address - Fax:
Practice Address - Street 1:10067 SANDMEYER LN
Practice Address - Street 2:SUITE 212
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3533
Practice Address - Country:US
Practice Address - Phone:215-399-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30023601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care