Provider Demographics
NPI:1962846709
Name:KC PBG HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:KC PBG HEALTH CENTER, LLC
Other - Org Name:LA POSADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KOHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-804-5900
Mailing Address - Street 1:5790 FLEET ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4703
Mailing Address - Country:US
Mailing Address - Phone:760-804-5900
Mailing Address - Fax:760-804-5909
Practice Address - Street 1:3600 MASTERPIECE WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2872
Practice Address - Country:US
Practice Address - Phone:561-514-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility