Providence in-Home Care, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PROVIDENCE IN-HOME CARE, INC.

Doing business as

Providence Skilled Nursing Care

Practice address

1401 Mercantile Lane
Suite # 200 Aa
Largo, MD 20774

Phone

(301) 490-5900

Fax

(301) 830-8335

NPI assigned

Aug 1, 2019

Last updated

Aug 1, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Betty W. Mwenje

Title

Administrator/President

Phone

(301) 490-5900

Specialties & licenses 1

Addresses

Other names 1

• Providence Skilled Nursing Care Doing business as

Locations

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564617600000",
    "number": "1083268544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8503",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223068503",
            "telephone_number": "301-490-5900",
            "fax_number": "301-830-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LANE",
            "address_2": "SUITE # 200 AA",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "20774",
            "telephone_number": "301-490-5900",
            "fax_number": "301-830-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE IN-HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-01",
        "last_updated": "2019-08-01",
        "status": "A",
        "authorized_official_last_name": "MWENJE",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ADMINISTRATOR/PRESIDENT",
        "authorized_official_telephone_number": "301-490-5900"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Skilled Nursing Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.