Organization
PROVIDENT HEALTH CARE INC
Active
Other names
Provident Riverside
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY TIU (CEO)
(209) 388-1002
Entity
Organization
Contact information
Practice address
1331 RIVERSIDE CT, MERCED, CA 95348-8409
(209) 388-1002
(209) 388-1007
Mailing address
1238 CATALINA DR, MERCED, CA 95348-9515
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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