Provider Demographics
NPI:1073973129
Name:A.K. BEAN FOUNDATION
Entity Type:Organization
Organization Name:A.K. BEAN FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-451-9703
Mailing Address - Street 1:600 NUT TREE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4686
Mailing Address - Country:US
Mailing Address - Phone:707-451-9703
Mailing Address - Fax:707-446-0471
Practice Address - Street 1:600 NUT TREE RD STE 240
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4686
Practice Address - Country:US
Practice Address - Phone:707-451-9703
Practice Address - Fax:707-446-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)