Organization
PROVIDENT CARE RESIDENTIAL HOME LLC
Active
Other names
PROVIDENT HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
NADINE ELLIS-MCINTYRE (ADMINISTRATOR)
(321) 443-5470
Entity
Organization
Contact information
Practice address
4170 MUTTER RD, SAINT CLOUD, FL 34769-6836
(407) 556-3406
(407) 556-3406
Mailing address
4170 MUTTER RD, SAINT CLOUD, FL 34769-6836
(407) 556-3406
(407) 556-3406
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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