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General NPI Number Information
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NPI Number | 1740664762
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Entity Type | Organization
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Legal Business Name | KUMQUAT HOLDINGS, LLC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 515 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-3215
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Country | US
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Telephone | 310-674-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 262 N UNIVERSITY AVE
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City | FARMINGTON
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State | UT
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Zip | 84025-2975
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN MITCHELL
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Credential |
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Telephone | 385-988-3319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 910000024
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License Number State | CA
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