Organization
PROVIDENT HEALTH CARE INC.
Active
Other names
PROVIDENT HEALTH CARE WINDY GAP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY TIU (LICENSEE)
(209) 723-4888
Entity
Organization
Contact information
Practice address
42406 WINDY GAP DR, AHWAHNEE, CA 93601
(559) 683-8020
(209) 722-7087
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
3480108
CA
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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