Healthcare Provider Details

I. General information

NPI: 1073973079
Provider Name (Legal Business Name): SOCIAL COMMUNITIES AND INDEPENDENT LIVING SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
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: 661-529-0133
  • Fax:
Mailing address:
  • Phone: 661-529-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number157207092
License Number StateCA

VIII. Authorized Official

Name: ROSANDA ANDERSON-WEST
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 661-599-0837