Basic Information
| Provider Information | |||||||||
| NPI: | 1144249228 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLEASANT CARE CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PLEASANT CARE CONVALESCENT BAKERSFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2258 FOOTHILL BLVD STE 6 | ||||||||
| Address2: | |||||||||
| City: | LA CANADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910111476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182489808 | ||||||||
| FaxNumber: | 8185417072 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 34TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613277687 | ||||||||
| FaxNumber: | 6613270236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PADRE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8182489808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC55702F | 05 | CA | MEDICAID |