Healthcare Provider Details

I. General information

NPI: 1356818660
Provider Name (Legal Business Name): PARKSIDE CONGREGATE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HAGGIN ST
BAKERSFIELD CA
93309-1972
US

IV. Provider business mailing address

304 HAGGIN ST
BAKERSFIELD CA
93309-1972
US

V. Phone/Fax

Practice location:
  • Phone: 661-374-4079
  • Fax: 661-748-1247
Mailing address:
  • Phone: 661-374-4079
  • Fax: 661-748-1247

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: MR. PETER YUZON
Title or Position: PRESIDENT
Credential:
Phone: 661-374-4079