Organization
PROVIDENT HEALTH CARE 619
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY TIU (EXECUTIVE DIRECTOR)
(209) 725-1770
Entity
Organization
Contact information
Practice address
44665 ROAD 619, MERCED, CA 95348
(209) 725-1770
Mailing address
1331 RIVERSIDE CT, MERCED, CA 95348-8409
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
3470423
CA
Other
Enumeration date
03/13/2015
Last updated
03/13/2015
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