Provider Demographics
NPI:1356658652
Name:KAISER GROUP OF MEDICAL CLINICS AND RESIDENTIAL FACILITIES, INC.
Entity type:Organization
Organization Name:KAISER GROUP OF MEDICAL CLINICS AND RESIDENTIAL FACILITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:670-234-8005
Mailing Address - Street 1:P.O. BOX 502213
Mailing Address - Street 2:MARIANAS BUSINESS PLAZA BLDG, ROOM 402, NAURU LOOP ST
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-2213
Mailing Address - Country:US
Mailing Address - Phone:670-234-8005
Mailing Address - Fax:670-234-8028
Practice Address - Street 1:NAURU LOOP ST. MARIANS BUSINESS PLAZA
Practice Address - Street 2:4TH FLOOR ROOM 402
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-2213
Practice Address - Country:US
Practice Address - Phone:670-234-8005
Practice Address - Fax:670-234-8028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER GROUP OF MEDICAL CLINICS AND RESIDENTIAL FACILITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-08
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP17362-0002-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health