Healthcare Provider Details

I. General information

NPI: 1407016140
Provider Name (Legal Business Name): KINGS/TULARE AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W MINERAL KING AVE SUITE C
VISALIA CA
93291-5635
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-9920
  • Fax: 559-624-1042
Mailing address:
  • Phone: 559-624-8000
  • Fax: 559-624-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA A. SILVA
Title or Position: KTAAA DIRECTOR
Credential:
Phone: 559-324-8006