Healthcare Provider Details

I. General information

NPI: 1588663769
Provider Name (Legal Business Name): KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2000
  • Fax: 559-713-2356
Mailing address:
  • Phone: 559-624-2739
  • Fax: 559-713-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number120000580
License Number StateCA

VIII. Authorized Official

Name: MALINDA TUPPER
Title or Position: SRVP/CHIEF FINANCIAL OFFICER
Credential:
Phone: 559-624-4065