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NPI Code Detail

MEDICARE: KSM HEALTHCARE, INC.

MEDICARE: KSM HEALTHCARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility920000028CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952366460
Entity Type Code : Organization
Provider Name (Legal Business Name) : KSM HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 1400 W GLENOAKS BOULEVARD
Second Line :
City : GLENDALE
State : CA
Zip : 91201-1911
Country : US
Telephone Number : 818-242-1183
Fax Number : 818-246-1085
Provider Business Practice Location Address
First Line : 1400 W GLENOAKS BOULEVARD
Second Line :
City : GLENDALE
State : CA
Zip : 91201-1911
Country : US
Telephone Number : 818-242-1183
Fax Number : 818-246-1085
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. JOHN CURT HAEDRICH
Credential : NHA
Telephone Number : 818-242-1183
Provider Enumeration Date : 04/18/2006
Last Update Date : 11/21/2011

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Directions to “KSM HEALTHCARE, INC. ” Practice Location

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