Healthcare Provider Details

I. General information

NPI: 1336594811
Provider Name (Legal Business Name): KINGSTON HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 REAL RD
BAKERSFIELD CA
93309-1982
US

IV. Provider business mailing address

5670 WILSHIRE BLVD STE 1862
LOS ANGELES CA
90036-5679
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-7107
  • Fax: 661-327-1152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120000169
License Number StateCA

VIII. Authorized Official

Name: DAVID SILVER
Title or Position: MANAGER
Credential:
Phone: 626-800-1191