=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801619325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVANNA ASSISTED LIVING II
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4104 RIO VIEJO DR
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-556-4752
-----------------------------------------------------
Fax | 661-412-4446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16616 MILLWOOD WAY
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93314-8221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-556-4752
-----------------------------------------------------
Fax | 661-412-4448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SARAH ADHIAMBO MAZIBUKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-742-3141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------