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General NPI Number Information
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NPI Number | 1235368614
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Entity Type | Organization
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Legal Business Name | JOSEPHINE KERNES MEMORIAL POOL, INC
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 15 PORTOLA AVE
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City | MONTEREY
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State | CA
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Zip | 93940-3731
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Country | US
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Telephone | 831-643-9867
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Fax | 831-643-9866
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Provider Business Mailing Address
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Address Line | 15 PORTOLA AVE
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City | MONTEREY
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State | CA
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Zip | 93940-3731
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Country | US
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Telephone | 831-643-9867
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Fax | 831-643-9866
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEBRA TRENT
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Credential |
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Telephone | 831-643-9867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | C0665286
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License Number State | CA
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