Healthcare Provider Details

I. General information

NPI: 1356195614
Provider Name (Legal Business Name): CONNIE-1 CONGREGATE FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 BASQUE ST
BAKERSFIELD CA
93313-2176
US

IV. Provider business mailing address

1100 VALENCIA DR
BAKERSFIELD CA
93306-5970
US

V. Phone/Fax

Practice location:
  • Phone: 661-412-4932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ELITANIA PARAMO-GARCIA
Title or Position: MANAGING MEMBER
Credential:
Phone: 831-710-3258