Provider Demographics
NPI:1699725739
Name:KERN HOME HEALTH RESOURCES
Entity type:Organization
Organization Name:KERN HOME HEALTH RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:PONZIO, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-672-8631
Mailing Address - Street 1:1675 BROADWAY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4675
Mailing Address - Country:US
Mailing Address - Phone:303-672-8631
Mailing Address - Fax:303-298-0047
Practice Address - Street 1:3101 SILLECT AVE
Practice Address - Street 2:#109
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6348
Practice Address - Country:US
Practice Address - Phone:661-325-8326
Practice Address - Fax:661-325-6509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KERN HOME HEALTH RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000325251E00000X, 251F00000X
CA261QI0500X
CA-PHY48940332B00000X
CAPHY 41725332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0522474OtherNCPDP
CA120000325OtherHOME HEALTH AGENCY
CAPHA417250Medicaid
CA-PHY48940OtherPHARMACY LICENSE
CA-PHY48940OtherPHARMACY LICENSE
0601630001Medicare NSC
CA120000325OtherHOME HEALTH AGENCY