=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699476234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERN BEHAVIORAL HEALTH & RECOVERY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2023
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 N CHESTER AVE STE C
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-1770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-376-8103
-----------------------------------------------------
Fax | 661-868-1841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 N CHESTER AVE STE C
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-1770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-376-8103
-----------------------------------------------------
Fax | 661-868-1841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RECOVERY SPECIALIST
-----------------------------------------------------
Name | SHERRY NICOLE BOWDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-376-8103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------