PROVIDENT PLACE NPI 1588006860

NPI Information

PROVIDENT PLACE is an intermediate care facility mentally retarded in Victorville, CA. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PROVIDENT PLACE NPI is 1588006860. The provider is registered as an organization entity type.

The provider's business location address is:

13943 TRIGGER LN
VICTORVILLE, CA
ZIP 92392-333
Phone: (760) 241-7634

The provider's authorized official is Dan Aparicio .
The authorized official title is President and has the following contact phone number (626) 722-1352.

The enumeration date for this NPI number is 7/26/2013 and was last updated on 7/26/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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