# PROVIDENT MEMORY CARE GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Provident Memory Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992136626
- **Authorized official:** MELANIE GAGLIARDO (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (210) 385-5416

## Contact information

- **Practice address:** 1810 N WASHINGTON AVE, LIVINGSTON, TX 77351-2130
- **Practice address phone:** (936) 327-8195
- **Mailing address:** 1810 N WASHINGTON AVE, LIVINGSTON, TX 77351-2130
- **Mailing address phone:** (936) 327-8195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | 137498 | TX | — |
| 311500000X | Alzheimer Center (Dementia Center) | 102962 | TX | Yes |

## Other

- **Enumeration date:** 12/05/2013
- **Last updated:** 03/18/2021