=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881191781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERN COUNTY REGIONAL DIALYSIS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2018
-----------------------------------------------------
Last Update Date | 01/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2661 OSWELL ST STE B
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93306-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-871-3461
-----------------------------------------------------
Fax | 661-871-3464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2661 OSWELL ST STE B
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93306-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-922-3080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF NURSING OFFICER
-----------------------------------------------------
Name | SARA ANNE BRADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-371-7878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------