Provider Demographics
NPI:1184759227
Name:KELLY & SCOTT'S CARE HOME INC.
Entity type:Organization
Organization Name:KELLY & SCOTT'S CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-359-4481
Mailing Address - Street 1:PO BOX 1957
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-1957
Mailing Address - Country:US
Mailing Address - Phone:559-783-1769
Mailing Address - Fax:559-791-1601
Practice Address - Street 1:2212 5TH DR
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-4239
Practice Address - Country:US
Practice Address - Phone:559-783-1769
Practice Address - Fax:559-791-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000479313M00000X
CA120000673313M00000X
CA120000624313M00000X
315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility