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Organization
PROVIDENT MEMORY CARE GROUP, LLC
Active
Organization
PROVIDENT MEMORY CARE GROUP, LLC
Active
Other names
Sodalis Elder Living
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHAWN CORZINE (CEO)
(830) 624-1044
Entity
Organization
Contact information
Practice address
11013 SIGNAL HILL DR, AUSTIN, TX 78737-2834
(512) 637-5400
Mailing address
195 S ACADEMY AVE, NEW BRAUNFELS, TX 78130-5607
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
142956
TX
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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