Healthcare Provider Details

I. General information

NPI: 1821380908
Provider Name (Legal Business Name): KATERA'S KOVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 NORWOOD DR
WAMPUM PA
16157-2505
US

IV. Provider business mailing address

599 NORWOOD DR
WAMPUM PA
16157-2505
US

V. Phone/Fax

Practice location:
  • Phone: 724-891-6055
  • Fax: 724-891-3401
Mailing address:
  • Phone: 724-891-6055
  • Fax: 724-891-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number401722
License Number StatePA

VIII. Authorized Official

Name: LYNN MARIE KATEKOVICH
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 724-891-6055