Organization
PROVIDIAN RESIDENTIAL CARE SERVICES, INC.
Active
Other names
Fillmore Christian Garden
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMEN JAMILI MILLY (ACCOUNTANT/OWNER)
(559) 284-6183
Entity
Organization
Contact information
Practice address
4826 E FILLMORE AVE, FRESNO, CA 93727-3701
(559) 284-6183
(559) 452-1536
Mailing address
4826 E FILLMORE AVE, FRESNO, CA 93727-3701
(559) 284-6183
(559) 452-1536
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
107202478
CA
Other
Enumeration date
10/05/2011
Last updated
02/07/2012
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