Provider Demographics
NPI:1619615689
Name:PROVIDENT SENIOR SOLUTIONS, INC.
Entity type:Organization
Organization Name:PROVIDENT SENIOR SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-578-1210
Mailing Address - Street 1:PO BOX 3558
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-3558
Mailing Address - Country:US
Mailing Address - Phone:120-957-8121
Mailing Address - Fax:
Practice Address - Street 1:1025 14TH ST
Practice Address - Street 2:MODESTO, CA 95354
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-9535
Practice Address - Country:US
Practice Address - Phone:209-595-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)