Healthcare Provider Details

I. General information

NPI: 1891980876
Provider Name (Legal Business Name): LIFEHOUSE PARKVIEW OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N. REAL RD.
BAKERSFIELD CA
93309
US

IV. Provider business mailing address

1000 CORPORATE POINTE STE 100
CULVER CITY CA
90230
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-7107
  • Fax: 661-327-3943
Mailing address:
  • Phone: 310-337-1929
  • Fax: 310-348-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRACY L. CLARK JR.
Title or Position: SECRETARY
Credential:
Phone: 310-337-1929