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Organization
PROVIDENT HEALTH CARE INC.
Active
Organization
PROVIDENT HEALTH CARE INC.
Active
Other names
PROVIDENT HEALTH CARE WINDY GAP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY TIU (LICENSEE)
(209) 723-4888
Entity
Organization
Contact information
Practice address
42406 WINDY GAP DR, AHWAHNEE, CA 93601
(559) 683-8020
(209) 722-7087
Mailing address
1238 CATALINA DR, MERCED, CA 95348-9515
(209) 723-4888
(209) 722-7087
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3480108
CA
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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