Providence Home Care L.L.C

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

Legal business name

PROVIDENCE HOME CARE L.L.C

Doing business as

Providence Home Care L.L.C

Practice address

3965 4TH St E
West Fargo, ND 58078-2865

Phone

(701) 709-0799

NPI assigned

Sep 1, 2020

Organization subpart

No

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

Authorized official

Name

Kojo Alexander

Title

C.F.O

Phone

(701) 709-0799

Specialties & licenses 9

Addresses

Other names 1

• Providence Home Care L.L.C Doing business as

Tax ID family

Providence Home Care LLC2 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 Home Care L.L.C

  • Personal Care Attendant
  • West Fargo, ND
  • NPI 1689320988
  NPD tax ID

Locations

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1861006439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 4TH ST E",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580782865",
            "telephone_number": "701-709-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 4TH ST E",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580782865",
            "telephone_number": "701-709-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOME CARE L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-01",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "KOJO",
        "authorized_official_title_or_position": "C.F.O",
        "authorized_official_telephone_number": "701-709-0799"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Home Care L.L.C",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Home Care L.L.C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual & Developmental Disabilities Psychologist in West Fargo, ND
• Providers in West Fargo, ND by specialty
• Intellectual & Developmental Disabilities Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.