Basic Information
| Provider Information | |||||||||
| NPI: | 1407971518 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF KERN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ELDERLIFE ADULT DAY HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 FLOWER ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933054144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613262102 | ||||||||
| FaxNumber: | 6613262100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 COLUMBUS ST | ||||||||
| Address2: | SUITE 5000 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933051936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613266598 | ||||||||
| FaxNumber: | 6613266593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CULBERSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 6613262102 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | ADU7102F | 05 | CA | MEDICAID |