1427049964 NPI number — KERN VALLEY HEALTHCARE DISTRICT

Table of content: (NPI 1427049964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427049964 NPI number — KERN VALLEY HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERN VALLEY HEALTHCARE DISTRICT
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:
1427049964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ISABELLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93240-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-379-2681
Provider Business Mailing Address Fax Number:
760-379-4795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6412 LAUREL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240-9529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-379-2681
Provider Business Practice Location Address Fax Number:
760-379-4795
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
760-379-2681

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  120000183 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 120000183 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHE40272 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PHA402720 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0094370 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08561F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40542F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAP08561F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC30542F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08527F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0503830 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: LTC55517F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BCP08561F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30542F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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