Provider Demographics
NPI:1457854192
Name:KERN VALLEY HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:KERN VALLEY HEALTHCARE DISTRICT
Other - Org Name:KERN VALLEY HEALTHCARE DISTRICT RHC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-379-2681
Mailing Address - Street 1:6412 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9529
Mailing Address - Country:US
Mailing Address - Phone:760-379-2681
Mailing Address - Fax:760-379-4795
Practice Address - Street 1:4300 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:MT MESA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-1791
Practice Address - Fax:760-379-1793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERN VALLEY HEALTHCARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000183261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08561FMedicaid