=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023382637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST CECI'S CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2012
-----------------------------------------------------
Last Update Date | 02/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 ROCKVALE DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-797-2038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 ROCKVALE DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-797-2038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. CARLOS ARMANDO CACERES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-797-2038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------