Provident Care Residential Home LLC
NPI #1578150397 in Saint Cloud, Florida
Provider Information
- NPI Number
- 1578150397
- Entity Type
- Organization
- Organization Name
- Provident Care Residential Home LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Dec 28, 2020
- Last Updated
- Dec 28, 2020
Practice Location
- Address
- 4170 MUTTER RD
- City
- Saint Cloud
- State
- Florida
- ZIP Code
- 34769-6836
- Phone
- (407) 556-3406
Authorized Official
- Name
- NADINE ELLIS-MCINTYRE
- Title
- ADMINISTRATOR
- Phone
- (321) 443-5470
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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