Provider Demographics
NPI:1740278720
Name:SAN JOAQUIN COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:SAN JOAQUIN COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-395-3000
Mailing Address - Street 1:2800 K ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2041
Mailing Address - Country:US
Mailing Address - Phone:661-869-6700
Mailing Address - Fax:661-631-9716
Practice Address - Street 1:2800 K ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2041
Practice Address - Country:US
Practice Address - Phone:661-631-1882
Practice Address - Fax:661-631-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000251251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07886FMedicaid
CAHHA07886FMedicaid