Providian Residential Care Services, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

107202478 Issued in CA

Legal business name

PROVIDIAN RESIDENTIAL CARE SERVICES, INC.

Doing business as

Fillmore Christian Garden

Practice address

4826 E Fillmore Ave
Fresno, CA 93727-3701

Phone

(559) 284-6183

Fax

(559) 452-1536

NPI assigned

Oct 5, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Carmen Jamili Milly

Title

Accountant/Owner

Phone

(559) 284-6183

Specialties & licenses 1

Addresses

Other names 1

• Fillmore Christian Garden Doing business as

Locations

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1922382290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4826 E FILLMORE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273701",
            "telephone_number": "559-284-6183",
            "fax_number": "559-452-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4826 E FILLMORE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273701",
            "telephone_number": "559-284-6183",
            "fax_number": "559-452-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDIAN RESIDENTIAL CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-05",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "MILLY",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "JAMILI",
        "authorized_official_title_or_position": "ACCOUNTANT/OWNER",
        "authorized_official_telephone_number": "559-284-6183",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "CA",
            "license": "107202478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fillmore Christian Garden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edwin Protacio, RN
• Brittany Breanne Protzman
• Dora Provencio
• Proveri Fresno LLC
• Providence Home Health Services LLC
• Benjamin James Pruett, D.O.
• Bradley Pruett, DC
• Shawna Pruitt
• Trish L Pruitt, CMT
• James Daniel Pryce, LCSW

• Assisted Living Facility (Mental Illness) in Fresno, CA
• Providers in Fresno, CA by specialty
• Assisted Living Facility (Mental Illness) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; 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.