Provider Demographics
NPI:1356818660
Name:PARKSIDE CONGREGATE LIVING, INC.
Entity Type:Organization
Organization Name:PARKSIDE CONGREGATE LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:YUZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-374-4079
Mailing Address - Street 1:304 HAGGIN ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1972
Mailing Address - Country:US
Mailing Address - Phone:661-374-4079
Mailing Address - Fax:661-748-1247
Practice Address - Street 1:304 HAGGIN ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1972
Practice Address - Country:US
Practice Address - Phone:661-374-4079
Practice Address - Fax:661-748-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1900155889OtherCITY BUSINESS LICENSE