Healthcare Provider Details

I. General information

NPI: 1285031674
Provider Name (Legal Business Name): SOCIAL COMMUNITIES AND INDEPENDENT LIVING SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 FOXBORO AVE
BAKERSFIELD CA
93309-5812
US

IV. Provider business mailing address

4509 FOXBORO AVE
BAKERSFIELD CA
93309-5812
US

V. Phone/Fax

Practice location:
  • Phone: 661-599-0837
  • Fax: 800-691-9109
Mailing address:
  • Phone: 661-599-0837
  • Fax: 800-691-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSANDA ANDERSON-WEST
Title or Position: CEO
Credential:
Phone: 661-829-4179