| NPI | 1578150397 |
|---|---|
| Doing Business As | PROVIDENT HOUSE |
| Entity Type | Organization |
| Authorized Contact | NADINE ELLIS-MCINTYRE Administrator 321-443-5470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2020-12-28 |