Healthcare Provider Details

I. General information

NPI: 1063800928
Provider Name (Legal Business Name): ANTELOPE VALLEY PARTNERS FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45104 10TH ST W
LANCASTER CA
93534-2310
US

IV. Provider business mailing address

45104 10TH ST W
LANCASTER CA
93534-2310
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-4719
  • Fax: 661-951-9715
Mailing address:
  • Phone: 661-942-4719
  • Fax: 661-951-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MICHELLE KIEFER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-942-4719