Provider Demographics
NPI:1114376589
Name:COMMUNITY KONNECTION DBA COMFORT KEEPERS
Entity Type:Organization
Organization Name:COMMUNITY KONNECTION DBA COMFORT KEEPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLMAN JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, MPT
Authorized Official - Phone:818-741-1991
Mailing Address - Street 1:6708 FOOTHILL BLVD., SUITE 206
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042
Mailing Address - Country:US
Mailing Address - Phone:818-741-1991
Mailing Address - Fax:818-741-1994
Practice Address - Street 1:6708 FOOTHILL BLVD., SUITE 206
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042
Practice Address - Country:US
Practice Address - Phone:818-741-1991
Practice Address - Fax:818-741-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA194700012OtherCALIFORNIA HCSB--CERTIFIED HCO