Provider Demographics
NPI:1073973079
Name:SOCIAL COMMUNITIES AND INDEPENDENT LIVING SUPPORT SERVICES
Entity Type:Organization
Organization Name:SOCIAL COMMUNITIES AND INDEPENDENT LIVING SUPPORT SERVICES
Other - Org Name:COMPANION CARE FACILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-599-0837
Mailing Address - Street 1:4509 FOXBORO AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5812
Mailing Address - Country:US
Mailing Address - Phone:661-529-0133
Mailing Address - Fax:
Practice Address - Street 1:4509 FOXBORO AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5812
Practice Address - Country:US
Practice Address - Phone:661-529-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1572070923104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances