1407016140 NPI number — KINGS/TULARE AREA AGENCY ON AGING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407016140 NPI number — KINGS/TULARE AREA AGENCY ON AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGS/TULARE AREA AGENCY ON AGING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407016140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5957 S MOONEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93277-9394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-624-8000
Provider Business Mailing Address Fax Number:
559-624-1042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 W MINERAL KING AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-730-9920
Provider Business Practice Location Address Fax Number:
559-624-1042
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SILVA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
KTAAA DIRECTOR
Authorized Official Telephone Number:
559-324-8006

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MSS00033F . This is a "LEGACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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