NPIMap

Organization Active NPI

Provident Health Care Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Merced, CA
National Provider Identifier
1730990839
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
PROVIDENT HEALTH CARE INC
Doing business as
Provident Riverside
Practice address
1331 Riverside CT
Merced, CA 95348-8409
Phone
(209) 388-1002
Fax
(209) 388-1007
NPI assigned
Jan 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Jerry Tiu
Title
Ceo
Phone
(209) 388-1002

Specialties & licenses 1

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

Addresses

Primary practice location

1331 Riverside CT
Merced, CA 95348-8409

Mailing address

1238 Catalina Dr
Merced, CA 95348-9515

Other names 1

  • Provident Riverside Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G708

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PROVIDENT HEALTH CARE-RIVERSIDE HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 11, 2014
Last certification
Apr 10, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
1331 Riverside CT
Merced, CA 95348

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1730990839",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 RIVERSIDE CT",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953488409",
            "telephone_number": "209-388-1002",
            "fax_number": "209-388-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "TIU",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-388-1002"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provident Riverside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merced, CA

Sources for this page

Verify at the official NPI Registry.