Basic Information
| Provider Information | |||||||||
| NPI: | 1407016140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINGS/TULARE AREA AGENCY ON AGING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5957 S MOONEY BLVD | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932779394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596248000 | ||||||||
| FaxNumber: | 5596241042 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 W MINERAL KING AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932915635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597309920 | ||||||||
| FaxNumber: | 5596241042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | SILVA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | KTAAA DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5593248006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | MSS00033F | 01 | CA | LEGACY | OTHER |