Provident Memory Care Group, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

102962 Issued in TX

Legal business name

PROVIDENT MEMORY CARE GROUP, LLC

Doing business as

Provident Memory Care Center

Practice address

1810 N Washington Ave
Livingston, TX 77351-2130

Phone

(936) 327-8195

NPI assigned

Dec 5, 2013

Last updated

Mar 18, 2021By 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

Melanie Gagliardo

Title

Director of Operations

Phone

(210) 385-5416

Specialties & licenses 2

Addresses

Other names 1

• Provident Memory Care Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

  dba Sodalis Elder Living

  • Alzheimer Center (Dementia Center)
  • Austin, TX
  • NPI 1891145595
  NPD tax ID

Locations

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1992136626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 N WASHINGTON AVE",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773512130",
            "telephone_number": "936-327-8195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 N WASHINGTON AVE",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773512130",
            "telephone_number": "936-327-8195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12515 Research Blvd",
            "address_2": "Bldg 7, Suite 200B",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787592228",
            "country_code": "US",
            "telephone_number": "512-284-9382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENT MEMORY CARE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-05",
        "last_updated": "2021-03-18",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "GAGLIARDO",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "210-385-5416"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "137498",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "TX",
            "license": "102962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provident Memory Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Provident Memory Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Yolanda Rangel

• Alzheimer Center (Dementia Center) in Livingston, TX
• Providers in Livingston, 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 Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.