Provident Health Care Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

3480108 Issued in CA

Legal business name

PROVIDENT HEALTH CARE INC.

Doing business as

Provident Health Care Windy Gap

Practice address

42406 Windy Gap Dr
Ahwahnee, CA 93601

Phone

(559) 683-8020

Fax

(209) 722-7087

NPI assigned

Feb 26, 2015

Last updated

Feb 26, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jerry Tiu

Title

Licensee

Phone

(209) 723-4888

Specialties & licenses 1

Addresses

Other names 1

• PROVIDENT HEALTH CARE WINDY GAP Doing business as

Tax ID family

Provident Health Care Inc3 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.

• Provident Health Care Inc

  dba Providenthealthcare-Tamarack Home

  • Intellectual Disabilities Intermediate Care Facility
  • Atwater, CA
  • NPI 1275879801
  NPD tax ID
• Provident Health Care L.L.C

  • Nursing Facility/Intermediate Care Facility
  • Merced, CA
  • NPI 1982853131
  NPD tax ID

Locations

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1598157604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 CATALINA DR",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953489515",
            "telephone_number": "209-723-4888",
            "fax_number": "209-722-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42406 WINDY GAP DR",
            "city": "AHWAHNEE",
            "state": "CA",
            "postal_code": "93601",
            "telephone_number": "559-683-8020",
            "fax_number": "209-722-7087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "TIU",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "209-723-4888",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "3480108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENT HEALTH CARE WINDY GAP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ahwahnee Care Homes, Inc.
• Rebecca Anne Bosworth
• Merced Health Care Inc.
• Lisa Marie Tribby-High, RN
• Sarah Zimmer

• Intellectual Disabilities Intermediate Care Facility in Ahwahnee, CA
• Providers in Ahwahnee, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.