Organization
PROVIDENT PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN APARICIO M.B.A. (PRESIDENT)
(626) 722-1352
Entity
Organization
Contact information
Practice address
15448 MONDAMON RD, APPLE VALLEY, CA 92307-4557
(760) 242-4908
Mailing address
964 E BADILLO ST # 523, COVINA, CA 91724-2950
(626) 722-1352
(626) 966-0650
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
07/26/2013
Last updated
07/26/2013
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