Provider Demographics
NPI: | 1700259165 |
---|---|
Name: | BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC |
Entity Type: | Organization |
Organization Name: | BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SOON |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | KIM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 248-839-5378 |
Mailing Address - Street 1: | 1450 W LONG LAKE RD |
Mailing Address - Street 2: | SUITE 340 |
Mailing Address - City: | TROY |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48098-6351 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-839-5378 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5201 WHITE LN |
Practice Address - Street 2: | |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93309-6200 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-398-1800 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-11-06 |
Last Update Date: | 2017-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 283Q00000X | Hospitals | Psychiatric Hospital |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 054155 | Medicare Oscar/Certification |