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General NPI Number Information
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NPI Number | 1245652064
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Entity Type | Organization
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Legal Business Name | KEEPSAKE KOTTAGE, LLC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 8801 W BEKEMEYER
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City | WICHITA
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State | KS
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Zip | 67212
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Country | US
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Telephone | 316-650-4526
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Fax |
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Provider Business Mailing Address
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Address Line | 8801 W BEKEMEYER ST 8801 W BEKEMEYER
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City | WICHITA
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State | KS
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Zip | 67212-4115
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Country | US
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Telephone | 316-650-4526
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Fax | 316-650-4526
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | KARI A CAMERON
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Credential | OPERATOR
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Telephone | 316-650-4526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | B087201
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License Number State | KS
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