Providence Healthcare Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

299992862 Issued in FL

Legal business name

PROVIDENCE HEALTHCARE SERVICES, INC.

Practice address

10250 SW 56TH St Ste D103
Miami, FL 33165-7065

Phone

(305) 220-1088

Fax

(305) 220-1086

NPI assigned

Sep 11, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Nercy Radcliffe

Title

Owner

Phone

(305) 220-1088

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Home health agency certification: CCN 109065

Legal name

PROVIDENCE HEALTHCARE SERVICES, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 30, 2008

Last certification

Oct 12, 2017

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Enrollment address

10250 SW 56TH St
Ste D103
Miami, FL 33165-7065
HHA Branch

Listed as

Providence Healthcare Services, IncCCN 109065

Overall star rating

3.5 of 5

Ownership

Proprietary

Certified

Jul 30, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Occupational therapy

Tax ID family

Providence Healthcare Services - Monroe2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Healthcare Services, Inc.

  • Home Health Agency
  • Miami, FL
  • NPI 1609456458
  NPD tax ID

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1477748614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10250 SW 56TH ST STE D103",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331657065",
            "telephone_number": "305-220-1088",
            "fax_number": "305-220-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10250 SW 56TH ST STE D103",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331657065",
            "telephone_number": "305-220-1088",
            "fax_number": "305-220-1086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4155 SW 130th Ave",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331753414",
            "country_code": "US",
            "telephone_number": "305-220-1088",
            "fax_number": "305-220-1086",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4155 SW 130th Ave",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331753414",
            "country_code": "US",
            "telephone_number": "305-220-1088",
            "fax_number": "305-220-1086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "RADCLIFFE",
        "authorized_official_first_name": "NERCY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-220-1088",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299992862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH AGENCY",
            "identifier": "299992862",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Provectus Health LLC
• Provena Care LLC
• Provena Medequip LLC
• Providence Community Center LLC
• Providence Healthcare
• Providence Healthcare Services, Inc.
• Providence Homecare LLC
• Providence Homecare LLC
• Providence Medical Center Inc
• Providence Professional Services Group Inc

• Home Health Agency in Miami, FL
• Providers in Miami, 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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.