- Enrollment id
- O20080529000163
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1245409010
- Multiple npi flag
- N
- Ccn
- 109423
- Associate id
- 5092885376
- Organization name
- PROVIDIA HOME CARE LLC
- Doing business as name
- PREFERRED CARE HOME HEALTH SERVICES
- Incorporation date
- 2007-10-10
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5292 SUMMERLIN COMMONS WAY 1102
- City
- FORT MYERS
- State
- FL
- Zip code
- 339072163