PROVIDENT PLACE (NPI# 1558703827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558703827 |
| Entity Type | Organization |
| Organization Name | PROVIDENT PLACE |
| Practice Address |
20400 Ituma Rd Apple Valley CA 92308-4445 |
| Mailing Address |
3604 N Danehurst Ave Covina CA 91724-3405 |
| Practice Telephone | 7609612880 |
| Mailing Telephone | 6267221352 |
| Mailing Fax Number | 6269660650 |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2013-07-26 |
| Authorized Official Name | MR. DAN APARICIO (PRESIDENT) |
| Authorized Official Telephone | 6267221352 |
| Authorized Official Credential | M.B.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760049621 | Provident Place | Behavioral Analyst | 611 Seneca Ridge Ave, N Las Vegas, NV 89084-1315 | 2019-05-24 |
| 1689028912 | Provident Place | Community/Behavioral Health | 418 Bradford Ln, Columbia, SC 29223-7131 | 2016-04-23 |
| 1588006860 | Provident Place | Intermediate Care Facility, Mentally Retarded | 13943 Trigger Ln, Victorville, CA 92392-6333 | 2013-07-26 |
| 1508208877 | Provident Place | Intermediate Care Facility, Mentally Retarded | 15448 Mondamon Rd, Apple Valley, CA 92307-4557 | 2013-07-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Provident Place Wealth Advisor s LLC | 1 White Street, Onancock, Virginia 23417 |
| Street Address |
20400 ITUMA RD |
| City | APPLE VALLEY |
| State | CA |
| Zip Code | 92308-4445 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467507087 | High Desert Haven, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 20400 Ituma Rd, Apple Valley, CA 92308-4445 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144831850 | Lisa K Frandsen | Behavioral Analyst | 19794 Poppy Rd, Apple Valley, CA 92308 | 2020-08-14 |
| 1518484195 | Jennifer Redwine | Behavioral Analyst | 1905 Business Center Drive South, Unit 100, San Bernardino, CA 92308 | 2017-08-24 |
| 1508397100 | West Care Transportation | Non-emergency Medical Transport (VAN) | 15480 Straight Arrow Rd #b, Apple Valley, CA 92308 | 2017-03-24 |
| 1811346497 | E Kim Dental Corp | Dentist | 21580 Bear Valley Rd., Ste B2-2, Apple Valley, CA 92308 | 2016-06-06 |
| 1134575376 | Seth Owuor | Pharmacist | 14426 Palmdale Road, Victorville, CA 92308 | 2016-05-06 |
| 1043608763 | Kamal Ebadpour | Adult Companion | 13224 Iroquois Road, Apple Valley, CA 92308 | 2015-01-05 |
| 1487099669 | Hateem Siddiqui | Internal Medicine | 19059 Bear Valley Rd # 3, Apple Valley, CA 92308 | 2013-05-01 |
| 1225305618 | Edward N. Sianipar | Nurse Practitioner | 19059 Bear Valley Rd., #1, Apple Valley, CA 92308 | 2011-11-29 |
| 1043508559 | Southern California Primary Medical Inc | Clinic/Center | 19341 Bear Valley Rd Ste 101, Apple Valley, CA 92308 | 2011-07-18 |
| 1396070959 | Asghar Ali Rajani | Registered Nurse | 19059 Bear Valley Road, Apple Valley, CA 92308 | 2009-10-14 |
| Find all providers in zip 92308 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508208877 | Provident Place | Intermediate Care Facility, Mentally Retarded | 15448 Mondamon Rd, Apple Valley, CA 92307-4557 | 2013-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215545538 | Vine Valley Homes II | Intermediate Care Facility, Mentally Retarded | 8400 Bellingham Ave, Sun Valley, CA 91352-3803 | 2020-07-22 |
| 1841811791 | Young Walker Inc. | Intermediate Care Facility, Mentally Retarded | 14 Deer Ct, Sacramento, CA 95823-4402 | 2020-05-01 |
| 1003441155 | Sunrise Premier Homes LLC | Intermediate Care Facility, Mentally Retarded | 13831 Ruther Ave, Paramount, CA 90723-2662 | 2020-03-10 |
| 1649805912 | Jingma Inc | Intermediate Care Facility, Mentally Retarded | 34909 Osprey Dr, Union City, CA 94587-4618 | 2020-03-07 |
| 1124661699 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 581 S Gilmar St, Anaheim, CA 92802-1306 | 2019-10-28 |
| 1467095935 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 1592 W Lorane Way, Anaheim, CA 92802-3930 | 2019-10-28 |
| 1992348460 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 5940 Los Angeles Way, Buena Park, CA 90620-2723 | 2019-10-28 |
| 1578106043 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2918 E Greenhedge Ave, Anaheim, CA 92806-3804 | 2019-10-28 |
| 1790328680 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 2143 W Fir Ave, Anaheim, CA 92801-3436 | 2019-10-23 |
| 1356984249 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 6540 Christine Cir, Buena Park, CA 90620-4511 | 2019-10-23 |
| Find all providers with the same taxonomy | ||||
| City | APPLE VALLEY |
| Zip Code | 92308 |
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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.