Providential Home Care of Nwa LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PROVIDENTIAL HOME CARE OF NWA LLC

Practice address

113 Parkwood St Ste B
Lowell, AR 72745-8811

Phone

(479) 668-4338

Fax

(888) 247-6285

NPI assigned

Jan 22, 2021

Organization subpart

No

Name

Mr. Mark Kersey

Title

Owner

Phone

(479) 668-4338

Locations

• Providential Home Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2021.

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1104416247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 PARKWOOD ST STE B",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727458811",
            "telephone_number": "479-668-4338",
            "fax_number": "888-247-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 PARKWOOD ST STE B",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727458811",
            "telephone_number": "479-668-4338",
            "fax_number": "888-247-6285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENTIAL HOME CARE OF NWA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "KERSEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-668-4338",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234403732",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark@providentialhc.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "113 Parkwood St Ste B",
            "city": "Lowell",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727458811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Providential Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Precision Health Care, Inc
• Precision Healthcare, Inc. Arkansas
• Present Day Health PA
• Dean B Priest Jr., MD
• Professional for Agility Care LLC
• Johanna Puff
• Ma Helena Garcia Quimbo, PT
• Raffy Laja Quimbo, PT
• Carrie L Rampey
• Nancy Rechtfertig, REGISTERED NURSE

• All providers in Lowell, AR
• In Home Supportive Care Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.