PROVIDENT MEMORY CARE GROUP, LLC (NPI# 1992136626) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992136626 |
| Entity Type | Organization |
| Organization Name | PROVIDENT MEMORY CARE GROUP, LLC |
| Practice Address |
12515 Research Blvd Bldg 7, Suite 200b Austin TX 78759-2228 |
| Mailing Address |
Po Box 340010 Lakeway TX 78734-0001 |
| Practice Telephone | 5122849382 |
| Mailing Telephone | 5122849382 |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2013-12-05 |
| Authorized Official Name | ALETA BONNER (PRESIDENT, MANAGING MEMBER) |
| Authorized Official Telephone | 2546243398 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | 137498 | TX | Nursing & Custodial Care Facilities |
| Y | 311500000X | Alzheimer Center (Dementia Center) | 102962 | TX | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891145595 | Provident Memory Care Group, LLC | Alzheimer Center (Dementia Center) | 11013 Signal Hill Dr, Austin, TX 78737-2834 | 2016-06-14 |
| Street Address |
12515 RESEARCH BLVD BLDG 7, SUITE 200B |
| City | AUSTIN |
| State | TX |
| Zip Code | 78759-2228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639348246 | William Dewayne Holmes | Psychiatry & Neurology | 12515 Research Blvd, Bldg 8, Suite 400, Austin, TX 78759-2228 | 2008-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677612 | Laurel Sunde | Nurse Practitioner | 11111 Research Blvd-ll2, Austin, TX 78759 | 2020-10-20 |
| 1558990242 | Sarah Ann Weier | Counselor | 8500 North Mopac Expressway, Austin, TX 78759 | 2020-04-03 |
| 1124672696 | Gabrielle Jade Hurley | Physical Therapist | 9333 Research Blvd Ste 400, Austin, TX 78759 | 2019-08-01 |
| 1730740671 | Jennifer Kraft | Behavior Technician | 9600 Great Hills Trail, Suite 150w, Austin, TX 78759 | 2019-06-21 |
| 1881199024 | Pediatric Home Healthcare, LLC | Home Health | 8501 N Mopac Expy Ste 410, Austin, TX 78759 | 2018-03-29 |
| 1679072870 | Sylvia Chen | Psychologist | 8400 N Mopac Expy Ste 302, Austin, TX 78759 | 2018-02-03 |
| 1215443064 | Greater Austin Urology, Pllc | Urology | 11673 Jollyville Rd Ste B101, Austin, TX 78759 | 2017-12-15 |
| 1831603042 | Jane A Dykes | Counselor | 9015 Mountain Ridge Dr., Houston Bldg., Ste. 200, Austin, TX 78759 | 2017-11-27 |
| 1134632706 | Gary Victor Friedman | Pharmacist | 4411 Spicewood Springs Road #1111, Austin, TN 78759 | 2017-11-06 |
| 1740720242 | Taylor Renee Cahill | Behavioral Analyst | 9901 North Capital of Texas Hwy, Austin, TX 78759 | 2017-03-02 |
| Find all providers in zip 78759 | ||||
| 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 |
|---|---|---|---|---|
| 1891145595 | Provident Memory Care Group, LLC | Alzheimer Center (Dementia Center) | 11013 Signal Hill Dr, Austin, TX 78737-2834 | 2016-06-14 |
| 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.