Healthcare Provider Details

I. General information

NPI: 1558681890
Provider Name (Legal Business Name): INDEPENDENT LIVING CENTER OF KERN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 30TH STREET
BAKERSFIELD CA
93301-1907
US

IV. Provider business mailing address

1631 30TH STREET
BAKERSFIELD CA
93301-1907
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-1063
  • Fax: 661-325-6702
Mailing address:
  • Phone: 661-325-1063
  • Fax: 661-325-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS E. LOPEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: B.A.
Phone: 661-325-1063