Healthcare Provider Details

I. General information

NPI: 1740278720
Provider Name (Legal Business Name): SAN JOAQUIN COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 K ST
BAKERSFIELD CA
93301-2041
US

IV. Provider business mailing address

2800 K ST
BAKERSFIELD CA
93301-2041
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-1882
  • Fax: 661-631-9716
Mailing address:
  • Phone: 661-869-6700
  • Fax: 661-631-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number120000251
License Number StateCA

VIII. Authorized Official

Name: MR. BRENT SOPER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 661-395-3000