NPIMap

Organization Active NPI

Provident Place

  • Intellectual Disabilities Intermediate Care Facility
  • Apple Valley, CA
National Provider Identifier
1508208877
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
PROVIDENT PLACE
Practice address
15448 Mondamon Rd
Apple Valley, CA 92307-4557
Phone
(760) 242-4908
NPI assigned
Jul 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dan Aparicio, M.B.A.
Title
President
Phone
(626) 722-1352

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

15448 Mondamon Rd
Apple Valley, CA 92307-4557

Mailing address

964 E Badillo St # 523
Covina, CA 91724-2950
Phone (626) 722-1352

National Provider Directory

National Provider Directory
Tax ID family
Provident Place3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374796800000",
    "number": "1508208877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 E BADILLO ST # 523",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917242950",
            "telephone_number": "626-722-1352",
            "fax_number": "626-966-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15448 MONDAMON RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923074557",
            "telephone_number": "760-242-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-26",
        "last_updated": "2013-07-26",
        "status": "A",
        "authorized_official_last_name": "APARICIO",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-722-1352",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.B.A."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.