Provision Homecare, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

HC2981 Issued in NC

Legal business name

PROVISION HOMECARE, LLC

Practice address

124 Main St E
Ahoskie, NC 27910-3416

Phone

(252) 332-4409

Fax

(252) 332-5099

NPI assigned

Aug 25, 2006

Organization subpart

No

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

Authorized official

Name

Phyllistine E Simmons

Title

Director Ceo

Phone

(252) 287-3562

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1255449922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 MAIN ST E",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279103416",
            "telephone_number": "252-332-4409",
            "fax_number": "252-332-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 MAIN ST E",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279103416",
            "telephone_number": "252-332-4409",
            "fax_number": "252-332-5099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 Evans St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278345302",
            "country_code": "US",
            "telephone_number": "252-287-3562",
            "fax_number": "252-862-8511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVISION HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "PHYLLISTINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR CEO",
        "authorized_official_telephone_number": "252-287-3562"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC2981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6601267",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY SUPPORT",
            "identifier": "8301311",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPS",
            "identifier": "3408323",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Ahoskie, NC
• Providers in Ahoskie, NC by specialty
• In Home Supportive Care Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2025; 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.