Providential Health Services, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDENTIAL HEALTH SERVICES, LLC

Practice address

200 Knuth Rd Ste 212B
Boynton Beach, FL 33436-4636

Phone

(561) 460-1717

NPI assigned

Nov 21, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexandra Dufort

Title

Secretary

Phone

(561) 707-3030

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1033755327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 KNUTH RD STE 212B",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334364636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 KNUTH RD STE 212B",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334364636",
            "telephone_number": "561-460-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENTIAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-21",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "DUFORT",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "561-707-3030"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.