Organization · Type 2 NPI

Provident Care Residential Home LLC

Assisted Living Facility · St. Cloud, FL

NPI number 1578150397 Active

Practice location

4170 Mutter Rd
St. Cloud, FL 34769-6836

Call (407) 556-3406 Map

Fax (407) 556-3406

Specialties and licenses

TaxonomyCodeLicense
Assisted Living Facility Primary 310400000XNone listed

Assisted Living Facility: A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

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About NPI 1578150397

Provident Care Residential Home LLC's National Provider Identifier is 1578150397, issued on Dec 28, 2020. The primary taxonomy on file is Assisted Living Facility (310400000X), and the practice location is in St. Cloud, FL. The record was last updated on Dec 28, 2020.