| Organization Name: | PROVISION HOME CARE INC |
| NPI Number: | 1700259264 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMMANUEL B OPOKU (PRESIDENT/MANAGER) |
| Mailing Address: | 9378 Olive Blvd Suite #215 Olivette |
| State: | MO US |
| Postal Code: | 631323215 |
| Phone Number: | 3145694121 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 11/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251F00000X |
| License Number: | SSBG/GR0008084 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Infusion |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |