Provider Demographics
NPI:1235368614
Name:JOSEPHINE KERNES MEMORIAL POOL, INC
Entity Type:Organization
Organization Name:JOSEPHINE KERNES MEMORIAL POOL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-643-9867
Mailing Address - Street 1:15 PORTOLA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3731
Mailing Address - Country:US
Mailing Address - Phone:831-643-9867
Mailing Address - Fax:831-643-9866
Practice Address - Street 1:15 PORTOLA AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3731
Practice Address - Country:US
Practice Address - Phone:831-643-9867
Practice Address - Fax:831-643-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0665286251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable