Providential Health Care, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDENTIAL HEALTH CARE, INC

Practice address

13400 Sutton Park Dr S
Suite 1101
Jacksonville, FL 32224-0236

Phone

(904) 992-2273

Fax

(904) 992-2270

NPI assigned

Apr 15, 2010

Organization subpart

No

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

Authorized official

Name

Lydia Florence Mwesigwa, RN

Title

Administrator

Phone

(214) 240-6146

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1235455239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13400 SUTTON PARK DR S",
            "address_2": "SUITE 1101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240236",
            "telephone_number": "904-992-2273",
            "fax_number": "904-992-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 SUTTON PARK DR S",
            "address_2": "SUITE 1101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240236",
            "telephone_number": "904-992-2273",
            "fax_number": "904-992-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENTIAL HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "MWESIGWA",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "FLORENCE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "214-240-6146",
        "authorized_official_credential": "RN"
    },
    "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": []
}

• Kimberly Proto-Conroy, APRN
• Jean T. Proulx
• Provenzano Counseling Services
• Liza Cristin Provenzano, LMHC
• Paul David Provenzano, DPT
• Aimee Lynn Provo, BS
• Georgette Louise Provost-Dukes, NURSE PRACTITIONER
• Jacob Prows
• Charles Howell Pruden IV, MD
• Kathryn Pruden, MD

• Home Health Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; 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.