# PROVIDENT CARE MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073757423
- **Authorized official:** MRS. LORI E. KOBETZ (MANAGER)
- **Authorized official phone:** (954) 294-5244

## Contact information

- **Practice address:** 6412 N UNIVERSITY DR, SUITE 120, TAMARAC, FL 33321-4055
- **Practice address phone:** (954) 726-7267
- **Practice address fax:** (954) 726-7776
- **Mailing address:** 6412 NORTH UNIVERSITY DRIVE, SUITE 120, TAMARAC, FL 33321-5568
- **Mailing address phone:** (954) 726-7267
- **Mailing address fax:** (954) 726-7776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2009
- **Last updated:** 09/29/2010