Healthcare Provider Details

I. General information

NPI: 1053155887
Provider Name (Legal Business Name): KEE CHA-E-NAR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KLAMATH BLVD.
KLAMATH CA
95548-1027
US

IV. Provider business mailing address

PO BOX 1027
KLAMATH CA
95548-1027
US

V. Phone/Fax

Practice location:
  • Phone: 707-482-1350
  • Fax:
Mailing address:
  • Phone: 707-482-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ABBY ABINANTI
Title or Position: BOARD CHAIRPERSON
Credential:
Phone: 707-482-1350