Provider Demographics
NPI:1114093127
Name:LOMA LINDA MANAGEMENT COMPANY, INC
Entity Type:Organization
Organization Name:LOMA LINDA MANAGEMENT COMPANY, INC
Other - Org Name:CHATEAU D BAKERSFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-322-4085
Mailing Address - Street 1:1011 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4703
Mailing Address - Country:US
Mailing Address - Phone:661-322-4085
Mailing Address - Fax:661-323-1059
Practice Address - Street 1:1011 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4703
Practice Address - Country:US
Practice Address - Phone:661-322-4085
Practice Address - Fax:661-323-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid