1669024121 NPI number — KALINGA CARE HOME

Table of content: (NPI 1669024121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669024121 NPI number — KALINGA CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALINGA CARE HOME
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:
1669024121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 VANCOUVER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERMORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94550-6028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-576-0836
Provider Business Mailing Address Fax Number:
650-550-4267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 VANCOUVER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94550-6028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-580-4166
Provider Business Practice Location Address Fax Number:
650-550-4267
Provider Enumeration Date:
07/15/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUEVARRA
Authorized Official First Name:
BERNADET
Authorized Official Middle Name:
VIRAY
Authorized Official Title or Position:
ADMINISTRATOR / DON
Authorized Official Telephone Number:
650-576-0836

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5550005935 . This is a "CLHF LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1669024121 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".