Provider Demographics
NPI:1104008002
Name:LIFEHOUSE BAKERSFIELD OPERATIONS LLC
Entity Type:Organization
Organization Name:LIFEHOUSE BAKERSFIELD OPERATIONS LLC
Other - Org Name:THE ORCHARDS POST-ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-337-1929
Mailing Address - Street 1:730 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2210
Practice Address - Country:US
Practice Address - Phone:661-327-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555702Medicare Oscar/Certification
555702Medicare Oscar/Certification