PROVIDENT MEMORY CARE GROUP, LLC (NPI# 1891145595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891145595 |
| Entity Type | Organization |
| Organization Name | PROVIDENT MEMORY CARE GROUP, LLC |
| Other Organization Name | SODALIS ELDER LIVING |
| Practice Address |
11013 Signal Hill Dr Austin TX 78737-2834 |
| Mailing Address |
195 S Academy Ave New Braunfels TX 78130-5607 |
| Practice Telephone | 5126375400 |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-06-14 |
| Authorized Official Name | MICHAEL SHAWN CORZINE (CEO) |
| Authorized Official Telephone | 8306241044 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311500000X | Alzheimer Center (Dementia Center) | 142956 | TX | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Sodalis Elder Living | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992136626 | Provident Memory Care Group, LLC | Assisted Living Facility | 12515 Research Blvd, Bldg 7, Suite 200b, Austin, TX 78759-2228 | 2013-12-05 |
| Street Address |
11013 SIGNAL HILL DR |
| City | AUSTIN |
| State | TX |
| Zip Code | 78737-2834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629689864 | Chanelle Lynette Storey | Behavior Technician | Farm To Market Road 1826, Austin, TX 78737 | 2020-08-12 |
| 1699390062 | Victoria Ratliff | Behavior Technician | 8517 Fm Rd 1826, Austin, TX 78737 | 2020-06-11 |
| 1245718840 | Beatriz Ramirez | Licensed Vocational Nurse | 154 Pure Brook Way, Austin, TX 78737 | 2018-08-06 |
| 1538617378 | Andres Arismendi IIi | Dentist | 8517 Fm 1826, Building 1, Suite 500, Austin, TX 78737 | 2016-09-21 |
| 1386197689 | Ledgestone Management LLC | Assisted Living Facility | 13150 Four Star Blvd, Austin, TX 78737 | 2016-08-03 |
| 1558763284 | Capitol City Limo Austin | Transportation Broker | 1000 Gorman Springs, 12707 Fm 1826, Austin, TX 78737 | 2014-09-25 |
| 1972902427 | Green Apple Pediatric Dentistry, Pllc | Dentist | 11601 Us Hwy 290 West, Suite 105, Austin, TX 78737 | 2014-08-21 |
| 1083043574 | Kerri Lynn Salvatore | Speech-Language Pathologist | 260 Dorset Ln, Austin, TX 78737 | 2013-11-05 |
| 1730521113 | James William Green | Dermatology | 9108 Zyle Rd, Austin, TX 78737 | 2013-07-25 |
| 1457606642 | Aman Mohammed Odeh | Hospitalist | 7900 Farm To Market Rd 1826, Seton Southwest, Austin, TX 78737 | 2012-07-13 |
| Find all providers in zip 78737 | ||||
| Taxonomy Code | 311500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Alzheimer Center (Dementia Center) |
| A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer’s Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417362724 | Adcctx | Alzheimer Center (Dementia Center) | 4605 N 35 Hwy, Austin, TX 78722 | 2014-06-25 |
| 1467788760 | Esc Iv, L.p. | Alzheimer Center (Dementia Center) | 7709 Beckett Rd, Austin, TX 78749-2955 | 2009-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316584642 | Village Care Homes, LLC | Alzheimer Center (Dementia Center) | 414 Stephen F Austin Dr, Conroe, TX 77302-3140 | 2019-12-05 |
| 1255873907 | Ladybirds Senior Care Home LLC | Alzheimer Center (Dementia Center) | 4810 Aquagate Dr, Spring, TX 77373-4943 | 2016-11-11 |
| 1972051175 | Menox Care LLC | Alzheimer Center (Dementia Center) | 6922 Vialinda Dr, Houston, TX 77083-1155 | 2016-09-15 |
| 1154877975 | Faith Home Care Agency LLC | Alzheimer Center (Dementia Center) | 4003 Lake Brazos Ln, Richmond, TX 77406-8092 | 2016-08-31 |
| 1942660659 | Alzcare I, Ltd | Alzheimer Center (Dementia Center) | 550 Rock St, New Braunfels, TX 78130-4052 | 2016-02-24 |
| 1376903096 | Alzcare Waco, LLC | Alzheimer Center (Dementia Center) | 4308 N 19th St, Waco, TX 76708-1143 | 2016-02-24 |
| 1275993990 | Alzcare San Marcos, LLC | Alzheimer Center (Dementia Center) | 1001 Crepe Myrtle St, San Marcos, TX 78666-8201 | 2016-02-24 |
| 1477925626 | Go Operations 1 LLC | Alzheimer Center (Dementia Center) | 11777 Lebanon Road, Frisco, TX 75035 | 2015-10-28 |
| 1174908925 | Alzcare I Ltd | Alzheimer Center (Dementia Center) | 2728 Cottonwood Lane, Temple, TX 76502 | 2015-07-22 |
| 1619364965 | Huntington Creek Capital Vi, LLC | Alzheimer Center (Dementia Center) | 3000 Glacier Pass Lane, Cedar Park, TX 78613-7628 | 2015-04-23 |
| 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.