Healthcare Provider Details

I. General information

NPI: 1710522206
Provider Name (Legal Business Name): UNICORN GARDEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 EDITH LN
BAKERSFIELD CA
93304-6703
US

IV. Provider business mailing address

3817 EDITH LN
BAKERSFIELD CA
93304-6703
US

V. Phone/Fax

Practice location:
  • Phone: 661-834-7789
  • Fax: 661-834-2340
Mailing address:
  • Phone: 661-834-7789
  • Fax: 661-834-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM HUDNALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-834-7789