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General NPI Number Information
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NPI Number | 1376157446
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Entity Type | Organization
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Legal Business Name | KENAI RIVER HOLDINGS LLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 790 HOLMES ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4229
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Country | US
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Telephone | 925-583-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 16885 W BERNARDO DR STE 216
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City | SAN DIEGO
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State | CA
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Zip | 92127-1620
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Country | US
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Telephone | 858-798-5700
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | CURTIS RODRIGUEZ
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Credential |
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Telephone | 801-608-4065
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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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