Provider Demographics
NPI:1427019736
Name:KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:KAWEAH DELTA HEALTH CARE DISTRICT
Other - Org Name:KAWEAH DELTA PORTERVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-4065
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:559-624-2739
Mailing Address - Fax:
Practice Address - Street 1:385 PEARSON DR
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3305
Practice Address - Country:US
Practice Address - Phone:559-624-2000
Practice Address - Fax:559-713-2356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAWEAH DELTA HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000785261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12669ZOtherBLUE SHIELD
CACDC02642FMedicaid
CAZZZ12669ZOtherBLUE SHIELD