Provident Place
NPI #1508208877 in Apple Valley, California
Provider Information
- NPI Number
- 1508208877
- Entity Type
- Organization
- Organization Name
- Provident Place
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Jul 26, 2013
- Last Updated
- Jul 26, 2013
Practice Location
- Address
- 15448 MONDAMON RD
- City
- Apple Valley
- State
- California
- ZIP Code
- 92307-4557
- Phone
- (760) 242-4908
Authorized Official
- Name
- MR. DAN APARICIO, M.B.A.
- Title
- PRESIDENT
- Phone
- (626) 722-1352
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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