NPIMap

Organization Active NPI

Provident Health Care Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Atwater, CA
National Provider Identifier
1912718016
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 Tamarack
Practice address
1553 Tamarack Ave
Atwater, CA 95301-2743
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

1553 Tamarack Ave
Atwater, CA 95301-2743

Mailing address

1238 Catalina Dr
Merced, CA 95348-9515
Phone (209) 388-1002

Other names 1

  • Provident Tamarack Doing business as

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": "1912718016",
    "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": "209-388-1002",
            "fax_number": "209-388-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 TAMARACK AVE",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953012743",
            "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 Tamarack",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atwater, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.