Healthcare Provider Details

I. General information

NPI: 1215786538
Provider Name (Legal Business Name): MATHIAS EL TRIBE CHARITABLE TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 SUN DEVILS AVENUE
BAKERSFIELD CA
93313
US

IV. Provider business mailing address

MATHIAS EL TRIBE 4305 SUN DEVILS AVENUE
BAKERSFIELD CA
93313
US

V. Phone/Fax

Practice location:
  • Phone: 818-477-7244
  • Fax:
Mailing address:
  • Phone: 818-477-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MATHEW-ALLEN MCCASTER
Title or Position: CHIEF MATHIAS EL/ CTH
Credential: NP
Phone: 818-477-7244