Organization
PROVIDENT HEALTH CARE L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY R. TIU (ADMINISTRATOR)
(209) 723-4888
Entity
Organization
Contact information
Practice address
1238 CATALINA DR, MERCED, CA 95348-9515
(408) 828-6527
Mailing address
4092 ST TROPEZ CT, MERCED, CA 95348-9539
(209) 723-4888
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
N.A
—
Other
Enumeration date
09/11/2008
Last updated
09/11/2008
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