Organization
PROVIDENT HEALTH CARE INC
Active
Other names
PROVIDENTHEALTHCARE-TAMARACK HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY R. TIU (OWNER/LICENSEE)
(209) 723-4888
Entity
Organization
Contact information
Practice address
1553 TAMARACK AVE, ATWATER, CA 95301-2743
(209) 357-2212
(209) 557-5689
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
—
—
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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