Healthcare Provider Details

I. General information

NPI: 1821923673
Provider Name (Legal Business Name): KELSO AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CORDUROY RD
KELSO WA
98626-5341
US

IV. Provider business mailing address

600 3RD AVE FL 21
NEW YORK NY
10016-1916
US

V. Phone/Fax

Practice location:
  • Phone: 360-469-5060
  • Fax:
Mailing address:
  • Phone: 332-322-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS SPENCER
Title or Position: SR. VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 332-322-1990