Healthcare Provider Details

I. General information

NPI: 1528302577
Provider Name (Legal Business Name): KRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N RENO ST
HAVEN KS
67543-9276
US

IV. Provider business mailing address

PO BOX 280
HAVEN KS
67543-0280
US

V. Phone/Fax

Practice location:
  • Phone: 620-465-2421
  • Fax: 620-465-2643
Mailing address:
  • Phone: 620-465-2421
  • Fax: 620-465-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberB078029
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN R ACHILLES
Title or Position: CEO
Credential:
Phone: 620-465-2421