Provider Demographics
NPI:1376723007
Name:CK I, INC.
Entity Type:Organization
Organization Name:CK I, INC.
Other - Org Name:CK I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:WENDELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-965-1118
Mailing Address - Street 1:43111 LEMONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4724
Mailing Address - Country:US
Mailing Address - Phone:661-965-1118
Mailing Address - Fax:661-965-1118
Practice Address - Street 1:43111 LEMONWOOD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4724
Practice Address - Country:US
Practice Address - Phone:661-965-1118
Practice Address - Fax:661-965-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001457315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities