Healthcare Provider Details

I. General information

NPI: 1750285359
Provider Name (Legal Business Name): KKARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 COUNTY ROAD 224
FORT BRIDGER WY
82933
US

IV. Provider business mailing address

PO BOX 342
FORT BRIDGER WY
82933-0342
US

V. Phone/Fax

Practice location:
  • Phone: 307-780-7785
  • Fax:
Mailing address:
  • Phone: 307-780-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KESHIA A GINES
Title or Position: PRESIDENT
Credential:
Phone: 307-780-7785