Healthcare Provider Details

I. General information

NPI: 1104299106
Provider Name (Legal Business Name): KIMA'S CONGREGATE LIVING FACILITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43801 HALCOM AVE
LANCASTER CA
93536-5819
US

IV. Provider business mailing address

43801 HALCOM AVE
LANCASTER CA
93536-5819
US

V. Phone/Fax

Practice location:
  • Phone: 323-434-3737
  • Fax:
Mailing address:
  • Phone: 323-434-3737
  • Fax:

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: ELMIRA JAMALYAN
Title or Position: CEO
Credential:
Phone: 323-434-3737