Provident Memory Care Group, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

142956 Issued in TX

Legal business name

PROVIDENT MEMORY CARE GROUP, LLC

Practice address

11013 Signal Hill Dr
Austin, TX 78737-2834

Phone

(512) 637-5400

NPI assigned

Jun 14, 2016

Organization subpart

No

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

Authorized official

Name

Michael Shawn Corzine

Title

Ceo

Phone

(830) 624-1044

Specialties & licenses 1

Addresses

Other names 1

• Sodalis Elder Living Doing business as

Tax ID family

Provident Memory Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Provident Memory Care Group, LLC

  • Alzheimer Center (Dementia Center)
  • Livingston, TX
  • NPI 1992136626
  NPD tax ID

Locations

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1891145595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 S ACADEMY AVE",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781305607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11013 SIGNAL HILL DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787372834",
            "telephone_number": "512-637-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT MEMORY CARE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "CORZINE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHAWN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-624-1044"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "TX",
            "license": "142956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sodalis Elder Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vincent Edward Provasek, MDPHD
• Markus Miller Provence, PHD
• Providacare Medical Supply LTD
• Providacare Medical Supply LTD
• Providence Service Corporation of Texas
• Providers 2 You, PLLC
• Providing Justice LLC
• Provista Eye Clinic
• Drew Provost, O.D.
• Kate Lindsay Provost, R.D., L.D.

• Alzheimer Center (Dementia Center) in Austin, TX
• Providers in Austin, TX by specialty
• Alzheimer Center (Dementia Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; 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.