Healthcare Provider Details

I. General information

NPI: 1316936776
Provider Name (Legal Business Name): AEW/CAREAGE-OPERATIONS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CALLOWAY DR BUILDING 'C:
BAKERSFIELD CA
93312-2974
US

IV. Provider business mailing address

350 CALLOWAY DR BUILDING 'C:
BAKERSFIELD CA
93312-2974
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-0182
  • Fax: 661-587-8053
Mailing address:
  • Phone: 661-587-0182
  • Fax: 661-587-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120000555
License Number StateCA

VIII. Authorized Official

Name: ARTHUE T HEITLAUF
Title or Position: CEO
Credential:
Phone: 253-853-2902