10D1078884 CLIA NUMBER - PROVIDIA HOME CARE CORP

Laboratory Demographics

CLIA Number: 10D1078884

Facility Name: PROVIDIA HOME CARE CORP

Facility Address:
5292 SUMMERLIN COMMONS WAY STE 1102
FORT MYERS, FL
ZIP 33907
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Facility Phone Number: 239 425-2670

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1245409010

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	10D1078884
LAB Type	Home Health Agency
Facility Name	PROVIDIA HOME CARE CORP
Street	5292 SUMMERLIN COMMONS WAY STE 1102
City	FORT MYERS
State	FL
ZIP	33907
Phone	239 425-2670
CertificateType	4
CertificateEffectiveDate	1/17/2024
CertificateExpirationDate	1/16/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024