MEDICARE: KERN VALLEY HEALTHCARE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	120000183	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	PHE40272	CA
4	3336C0003X	Community/Retail Pharmacy
5	3336L0003X	Long Term Care Pharmacy
6	282NC0060X	Critical Access Hospital	120000183	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0503830	OTHER	OTHER ID NUMBER
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427049964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERN VALLEY HEALTHCARE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 1628
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-1628
Country	:	US
Telephone Number	:	760-379-2681
Fax Number	:	760-379-4795

Provider Business Practice Location Address
First Line	:	6412 LAUREL AVE
Second Line	:
City	:	LAKE ISABELLA
State	:	CA
Zip	:	93240-9529
Country	:	US
Telephone Number	:	760-379-2681
Fax Number	:	760-379-4795

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	JEANNE OLSON
Credential	:
Telephone Number	:	760-379-2681

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/15/2014

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Directions to “KERN VALLEY HEALTHCARE DISTRICT ” Practice Location

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