Provider Demographics
NPI:1023167541
Name:COUNTY OF KERN
Entity type:Organization
Organization Name:COUNTY OF KERN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-321-3000
Mailing Address - Street 1:1800 MT. VERNON AVE, 3RD LEVEL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3302
Mailing Address - Country:US
Mailing Address - Phone:661-868-0300
Mailing Address - Fax:661-868-0352
Practice Address - Street 1:1800 MOUNT VERNON AVE FL 1
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-321-3000
Practice Address - Fax:661-868-0597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF KERN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLE1134251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70522FMedicaid
CACLE1134OtherCLINIC LICENSE