PROVIDENT PLACE (NPI# 1588006860) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588006860 |
| Entity Type | Organization |
| Organization Name | PROVIDENT PLACE |
| Practice Address |
13943 Trigger Ln Victorville CA 92392-6333 |
| Mailing Address |
964 E Badillo St # 523 Covina CA 91724-2950 |
| Practice Telephone | 7602417634 |
| 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 |
| 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 |
| 1558703827 | Provident Place | Intermediate Care Facility, Mentally Retarded | 20400 Ituma Rd, Apple Valley, CA 92308-4445 | 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 |
13943 TRIGGER LN |
| City | VICTORVILLE |
| State | CA |
| Zip Code | 92392-6333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245385889 | High Desert Haven, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 13943 Trigger Ln, Victorville, CA 92392-6333 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215568688 | Kristin Parris | Behavior Technician | 15490 Civic Drive, Victorville, CA 92392 | 2020-02-03 |
| 1366001604 | Pine Ridge Treatment Centers, Inc. | Substance Abuse Rehabilitation Facility | 15367 Bonanza Rd, Ste A, Victorville, CA 92392 | 2019-06-11 |
| 1851871289 | Betty A. Murphy, Lmft, Inc | Marriage & Family Therapist | 15437 Anacapa Rd. Ste 26, Victorville, CA 92392 | 2018-08-15 |
| 1104313402 | Jorge L Soler Iglesias | Nurse Practitioner | 12459 Cricket St., Victorville, CA 92392 | 2018-04-23 |
| 1689192049 | Jamesina Johns | Nurse Practitioner | 12127 Mall Blvd #148, Victorville, CA 92392 | 2017-09-06 |
| 1285151886 | Jasmin Sanchez | Behavioral Analyst | 13201 Eclipse Ave, Victorville, CA 92392 | 2017-08-24 |
| 1174049829 | Virginia Marshall | Behavioral Analyst | 13901 Amargosa Rd., Victorville, CA 92392 | 2017-08-15 |
| 1346781465 | San Bernardino Conty | Counselor | 15480 Ramona Ave., Victoville, CA 92392 | 2017-03-09 |
| 1841741279 | Lorinda Morreale | Marriage & Family Therapist | 15428 Civic Dr. Ste 200, Act Family Counseling, Victorville, CA 92392 | 2016-10-20 |
| 1235582404 | Greater Hope Foundation | Community/Behavioral Health | 14344 Cajon Avenue, Suite 101, 103, Victorville, CA 92392 | 2016-07-22 |
| Find all providers in zip 92392 | ||||
| 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 |
|---|---|---|---|---|
| 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 | VICTORVILLE |
| Zip Code | 92392 |
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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.