Provider Demographics
NPI:1073069761
Name:KERN COUNTY CCS
Entity Type:Organization
Organization Name:KERN COUNTY CCS
Other - Org Name:BAKERSFIELD MTU
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-868-1272
Mailing Address - Street 1:1800 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3302
Mailing Address - Country:US
Mailing Address - Phone:661-868-0533
Mailing Address - Fax:661-868-0268
Practice Address - Street 1:4110 PLANZ ROAD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5993
Practice Address - Country:US
Practice Address - Phone:661-868-7286
Practice Address - Fax:661-396-1033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERN COUNTY CCS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare