1699725739 NPI number — KERN HOME HEALTH RESOURCES

Table of content: (NPI 1699725739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699725739 NPI number — KERN HOME HEALTH RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERN HOME HEALTH RESOURCES
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:
CORAM HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1699725739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80202-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-672-8631
Provider Business Mailing Address Fax Number:
303-298-0047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 SILLECT AVE
Provider Second Line Business Practice Location Address:
#109
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93308-6348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-325-8326
Provider Business Practice Location Address Fax Number:
661-325-6509
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PONZIO, JR.
Authorized Official First Name:
VITO
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP
Authorized Official Telephone Number:
303-672-8631

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  120000325 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 120000325 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QI0500X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: -PHY48940 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: PHY 41725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHY 41725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY 41725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PHY 41725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X , with the licence number: PHY 41725 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0522474 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120000325 . This is a "HOME HEALTH AGENCY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHA417250 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: -PHY48940 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".