Healthcare Provider Details

I. General information

NPI: 1427187434
Provider Name (Legal Business Name): KAT'S ELDERCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53030 AURORA AVE.
KASILOF AK
99610
US

IV. Provider business mailing address

PO BOX 55
KASILOF AK
99610
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-0496
  • Fax: 907-260-3340
Mailing address:
  • Phone: 907-262-0496
  • Fax: 907-260-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number000238
License Number StateAK

VIII. Authorized Official

Name: KATHY ANN WALSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-262-0496