Provider Demographics
NPI:1104655513
Name:KINGS VIEW
Entity type:Organization
Organization Name:KINGS VIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NUGENT
Authorized Official - Last Name:DIVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-663-0752
Mailing Address - Street 1:1627 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4949
Mailing Address - Country:US
Mailing Address - Phone:559-387-9910
Mailing Address - Fax:
Practice Address - Street 1:1627 S GARDEN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4949
Practice Address - Country:US
Practice Address - Phone:559-387-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGS VIEW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)