Provider Demographics
NPI:1427049964
Name:KERN VALLEY HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:KERN VALLEY HEALTHCARE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-379-2681
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-1628
Mailing Address - Country:US
Mailing Address - Phone:760-379-2681
Mailing Address - Fax:760-379-4795
Practice Address - Street 1:6412 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9529
Practice Address - Country:US
Practice Address - Phone:760-379-2681
Practice Address - Fax:760-379-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000183282NC0060X, 314000000X
332B00000X, 3336C0003X, 3336L0003X
CAPHE40272333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA402720Medicaid
CAGR0094370Medicaid
CARHM08561FMedicaid
CAZZT40542FMedicaid
CAHAP08561FMedicaid
CALTC30542FMedicaid
CARHM08527FMedicaid
0503830OtherOTHER ID NUMBER
CALTC55517FMedicaid
CABCP08561FMedicaid
CAZZT30542FMedicaid
CA051314Medicare Oscar/Certification
CAZZZ92943ZMedicare PIN
CARHM08527FMedicaid
CA555517Medicare Oscar/Certification
CA0871640001Medicare PIN
CAGR0094370Medicaid
CA058561Medicare Oscar/Certification
CA05Z314Medicare Oscar/Certification
0871640001Medicare NSC