MEDICARE: KAN CARE NURSING PROFESSIONAL CORPORATION

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	620851	CA

General Provider Information

NPI Number	:	1740425826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN CARE NURSING PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3120 ARDMORE LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-6301
Country	:	US
Telephone Number	:	805-701-2255
Fax Number	:	805-201-3107

Provider Business Practice Location Address
First Line	:	3120 ARDMORE LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-6301
Country	:	US
Telephone Number	:	805-701-2255
Fax Number	:	805-201-3107

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CATHERINE NJERI KAMAU-ALI
Credential	:	RN, BSN, MSN.
Telephone Number	:	805-701-2255

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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