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General NPI Number Information
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NPI Number | 1093117657
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Entity Type | Organization
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Legal Business Name | KLLG CORPORATION
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 3231 DOLBEER ST
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City | EUREKA
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State | CA
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Zip | 95503-5631
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Country | US
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Telephone | 707-444-2076
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Fax | 707-444-2079
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Provider Business Mailing Address
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Address Line | PO BOX 408
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City | CUTTEN
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State | CA
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Zip | 95534-0408
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Country | US
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Telephone | 707-268-8699
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Fax | 707-442-9274
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. KAMARA GEE
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Credential |
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Telephone | 707-268-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126803492
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126803419
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License Number State | CA
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