=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740078682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERN COUNTY BRAIN INJURY FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 TRUXTUN AVE STE 220
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-0402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-735-4292
-----------------------------------------------------
Fax | 661-344-4266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5701 TRUXTUN AVE STE 220
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-0402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-735-4292
-----------------------------------------------------
Fax | 661-344-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. ADONICA N VICKERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-378-3764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------