Healthcare Provider Details

I. General information

NPI: 1467538520
Provider Name (Legal Business Name): BAKERSFIELD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 34TH ST
BAKERSFIELD CA
93301-2237
US

IV. Provider business mailing address

PO BOX 1888
BAKERSFIELD CA
93303-1888
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-4647
  • Fax: 661-637-0529
Mailing address:
  • Phone: 661-327-4647
  • Fax: 661-637-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120000181
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number120000181
License Number StateCA

VIII. Authorized Official

Name: JON VAN BOENING
Title or Position: PRESIDENT
Credential:
Phone: 661-327-1792