PROVIDENTHEALTHCARE-TAMARACK HOME
NPI 1275879801
Intermediate Care Facility, Intellectual Disabilities in Atwater, CA
About Providenthealthcare-tamarack Home NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENTHEALTHCARE-TAMARACK HOME (NPI 1275879801) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Atwater, California and active in the NPI registry since December 2012. The organization holds a CLIA Waiver certificate valid through October 27, 2026 and lists Jerry R. Tiu, Owner/licensee, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2121034
Provident Health Care Icf/Ddn · Atwater, CAOther Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ATWATER, CA 95301
ATWATER, CA 95301
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Provident Health Care Inc's NPI number?
The NPI number for Provident Health Care Inc is 1275879801. It was assigned to this organization in the NPPES registry on December 31, 2012. The provider is doing business as Providenthealthcare-Tamarack Home.
Where is Provident Health Care Inc located?
Provident Health Care Inc is located at 1553 Tamarack Ave, Atwater, CA 95301. The listed phone number is (209) 357-2212.
What is Provident Health Care Inc's specialty?
The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
Does Provident Health Care Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2121034) is associated with this NPI, valid through October 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Provident Health Care Inc was last updated on December 31, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Providenthealthcare-Tamarack Home · NPI 1275879801
Intermediate Care Facility, Intellectual Disabilities organization in Atwater, California. Organization record, active in the CMS NPPES registry since December 31, 2012.
## Identity
- **NPI:** 1275879801 (Entity type: Organization)
- **Enumerated:** December 31, 2012
- **Primary specialty:** Intermediate Care Facility, Intellectual Disabilities · taxonomy 315P00000X
- **Legal business name:** Provident Health Care Inc
- **Organization subpart:** No
- **Authorized official:** Jerry Tiu, OWNER/LICENSEE
## Practice location
- **Address:** 1553 TAMARACK AVE, Atwater, CA 95301-2743
- **Phone:** (209) 357-2212 · **Fax:** (209) 557-5689
## Record status
- **NPPES last updated:** December 31, 2012
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1275879801) · Data from the CMS NPPES public registry.