Provider Demographics
NPI:1093776338
Name:KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:KAWEAH DELTA HEALTH CARE DISTRICT
Other - Org Name:KAWEAH HEALTH SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-2739
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:559-624-2739
Mailing Address - Fax:559-713-2239
Practice Address - Street 1:1633 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4945
Practice Address - Country:US
Practice Address - Phone:559-624-2000
Practice Address - Fax:559-713-2356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAWEAH DELTA HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000580314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC90063FMedicaid
CA555396Medicare Oscar/Certification
CALTC70126FMedicare ID - Type UnspecifiedMEDI-CAL SUBACUTE