Healthcare Provider Details

I. General information

NPI: 1053858076
Provider Name (Legal Business Name): COACH NURSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 COMMERCIAL WAY SUITE 100
BAKERSFIELD CA
93309-0620
US

IV. Provider business mailing address

27321 DEERTRAIL DR
TEHACHAPI CA
93561-7448
US

V. Phone/Fax

Practice location:
  • Phone: 661-428-1567
  • Fax: 800-862-2668
Mailing address:
  • Phone: 661-428-1567
  • Fax: 800-862-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TONI M KOVAC
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 661-428-1567