PROVIDENT FOUNDATION - WEDGEWOOD TERRACE LLC (NPI# 1295228054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295228054 |
| Entity Type | Organization |
| Organization Name | PROVIDENT FOUNDATION - WEDGEWOOD TERRACE LLC |
| Practice Address |
2114 Vineyard Avenue Lewiston ID 83501 |
| Mailing Address |
5565 Bankers Avenue Baton Rouge LA 70808 |
| Practice Telephone | 2087434545 |
| Practice Fax Number | 2087432268 |
| Mailing Telephone | 2257663977 |
| Mailing Fax Number | 2257663988 |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |
| Authorized Official Name | DEBRA W. LOCKWOOD (PRESIDENT & CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2257663977 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
2114 VINEYARD AVENUE |
| City | LEWISTON |
| State | ID |
| Zip Code | 83501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679193759 | Jacqueline M Aldrich | Behavior Technician | 3407 12th Street C, 3407 12th Street C, Lewiston, ID 83501 | 2020-04-20 |
| 1164945325 | Xiaofei Liu | Massage Therapist | 234 Thain Rd, Lewiston, ID 83501 | 2017-07-19 |
| 1467909879 | Sharon Thulon | Registered Nurse | 1118 F Street, Lewiston, ID 83501 | 2016-09-01 |
| 1821459496 | Gem State Endoscopy | Clinic/Center | 3709 14th Street, Lewiston, ID 83501 | 2016-03-10 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1003189366 | John Joseph Johnson | Dentist | 3510 12th Street, Suite #600, Lewiston, ID 83501 | 2012-02-17 |
| 1306134077 | Rowena Kathryn Jackson | Counselor | 531 Bryden Avenue, Lewiston, ID 83501 | 2011-07-15 |
| 1912290388 | Staci Leanne Truby | Massage Therapist | 717 'd' Street, Lewiston, ID 83501 | 2011-05-18 |
| 1093040685 | Sharie Ann Uhlorn | Registered Nurse | 1837 Alder Court, Lewiston, ID 83501 | 2009-10-15 |
| 1295969004 | Linda L. Schroeder Golding | Social Worker | 312 Miller St., Riverplace Counseling, Lewiston, ID 83501 | 2009-05-07 |
| Find all providers in zip 83501 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609012277 | Living Spring Residential Care | Assisted Living Facility | 1050 Hemlock Dr, Lewiston, ID 83501-5434 | 2009-01-01 |
| 1588867196 | Unique Sr. Care Assisted Living | Assisted Living Facility | 1639 Birch Ave, Lewiston, ID 83501-5959 | 2007-06-09 |
| 1851422620 | Emeritus Properties II, Inc. | Assisted Living Facility | 2975 Juniper Drive, Lewiston, ID 83501 | 2007-03-07 |
| 1376940809 | Lewiston Royal Plaza Retirement, LLC | Assisted Living Facility | 2870 Juniper Dr, Lewiston, ID 83501-4720 | 2014-11-26 |
| 1871656983 | Lewiston Operations, LLC | Assisted Living Facility | 33 Roger St, Lewiston, ME 04240-3328 | 2006-12-19 |
| 1154350700 | Rousseau Enterprises, Inc. | Assisted Living Facility | 540 College St, Lewiston, ME 04240-5228 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407462906 | Etosha Assisted Living, Inc | Assisted Living Facility | 243 N 300 E, Rupert, ID 83350-9491 | 2020-09-20 |
| 1548886963 | Diamond View Care Properties, LLC | Assisted Living Facility | 3570 E Amity Rd, Meridian, ID 83642-7014 | 2020-06-22 |
| 1619593068 | Frontier Management, LLC | Assisted Living Facility | 10250 W Smoke Ranch Dr, Boise, ID 83709-1467 | 2020-06-22 |
| 1174149991 | Rsl Renaissance, LLC | Assisted Living Facility | 2772 W Avante Loop, Coeur D Alene, ID 83815-0333 | 2020-06-17 |
| 1891319141 | Grace At Caldwell LLC | Assisted Living Facility | 518 N 21st Ave, Caldwell, ID 83605-4368 | 2020-06-02 |
| 1790309045 | Grace At Fairview Lakes LLC | Assisted Living Facility | 1960 N Lakes Pl, Meridian, ID 83646-5939 | 2020-06-02 |
| 1164046413 | Grace Memory Care At State Street LLC | Assisted Living Facility | 9779 W State St, Boise, ID 83714-1638 | 2020-06-02 |
| 1356965693 | Grace At State Street LLC | Assisted Living Facility | 9995 W State St, Boise, ID 83714-1636 | 2020-06-02 |
| 1336763689 | Grace LLC | Assisted Living Facility | 1610 Sunnyridge Rd, Nampa, ID 83686-7401 | 2020-06-02 |
| 1447874797 | Grace At Englefield Green LLC | Assisted Living Facility | 250 S Allumbaugh Way, Boise, ID 83709-5624 | 2020-06-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.