Provider Demographics
NPI:1861007270
Name:COBBLE STONE RESIDENTIAL HOME CARE LLC.
Entity Type:Organization
Organization Name:COBBLE STONE RESIDENTIAL HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:C LARK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:661-397-0885
Mailing Address - Street 1:9320 COBBLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5373
Mailing Address - Country:US
Mailing Address - Phone:661-397-0885
Mailing Address - Fax:661-855-4409
Practice Address - Street 1:9320 COBBLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-5373
Practice Address - Country:US
Practice Address - Phone:661-397-0885
Practice Address - Fax:661-855-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548826860Medicaid