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General NPI Number Information
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NPI Number | 1063281665
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Entity Type | Organization
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Legal Business Name | KASHAMAT GROUP LLC
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 7535 BONNIE ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-4121
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Country | US
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Telephone | 909-884-3044
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Fax |
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Provider Business Mailing Address
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Address Line | 247 S MOUNTAIN VIEW AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1314
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Country | US
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Telephone | 909-884-3044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLODOVEO RILLO GOSUICO
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Credential |
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Telephone | 909-884-3044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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