Organization
PROVIDENT MEMORY CARE GROUP, LLC
Active
Other names
Sodalis Elder Living
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHAWN CORZINE (CEO)
(830) 624-1044
Entity
Organization
Contact information
Practice address
11013 SIGNAL HILL DR, AUSTIN, TX 78737-2834
(512) 637-5400
Mailing address
195 S ACADEMY AVE, NEW BRAUNFELS, TX 78130-5607
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
142956
TX
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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