Provision Home Care Agency, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVISION HOME CARE AGENCY, LLC

Practice address

3516 Vest Mill Rd Ste a
Winston Salem, NC 27103-3070

Phone

(336) 300-9005

NPI assigned

Jun 3, 2020

Last updated

Jun 3, 2020By 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

Mrs. Bertha Grinton Mitchell

Title

Owner

Phone

(336) 300-9005

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1629692710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3516 VEST MILL RD STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033070",
            "telephone_number": "336-300-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3516 VEST MILL RD STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033070",
            "telephone_number": "336-300-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION HOME CARE AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-03",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "BERTHA",
        "authorized_official_middle_name": "GRINTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-300-9005",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Prothero, CNM
• Erik Proulx, M.D.
• Hannah Kathleen Proulx, PA
• Delaney Elisabeth Provenza, PA
• John Michael Provenza, MD
• Brittany Marie Proxmire, MA, LCMHC-A
• Jaron Kai Pruett, MD
• Jean F Pruett, LPC
• Gina Dombalis Pruitt, MA, CCC-SLP
• Kelly Sheppard Pruitt, LCMHC

• Home Health Agency in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Home Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.