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Provident Place
Intellectual Disabilities Intermediate Care Facility in Apple Valley, California
NPI 1508208877

Provident Place is a Intellectual Disabilities Intermediate Care Facility based in Covina, CA. Provident Place practices in Apple Valley, CA. The NPI Number for Provident Place is 1508208877 and holds a License No. (California).

The current practice location address for Provident Place is 15448 Mondamon Rd, Apple Valley, CA and can be reached out via phone at 760-242-4908.

Location: 15448 Mondamon Rd, Apple Valley, CA, 91724-2950
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1508208877
Provider Name
Provident Place
Credential
Provider Entity Type
Organization
Address
15448 Mondamon Rd, Apple Valley, CA, 91724-2950
Phone Number
760-242-4908
Fax Number
Provider Enumeration Date
07/26/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
15448 Mondamon Rd
City
Apple Valley
State
California
Zip
92307-4557
Phone Number
760-242-4908
Fax Number
person
Provider Business Mailing Address Details
Address
15448 Mondamon Rd
City
Apple Valley
State
California
Zip
92307-4557
Phone Number
760-242-4908
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
()
Definition
(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.
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