Provider Demographics
NPI:1942624481
Name:LIFEHOUSE BAKERFIELD OPERATIONS LLC
Entity Type:Organization
Organization Name:LIFEHOUSE BAKERFIELD OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-337-1929
Mailing Address - Street 1:300 CORPORATE POINTE STE 550
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7617
Mailing Address - Country:US
Mailing Address - Phone:310-337-1929
Mailing Address - Fax:
Practice Address - Street 1:730 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2210
Practice Address - Country:US
Practice Address - Phone:661-322-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE HEALTH SERCIVES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555702Medicare UPIN