Provider Demographics
NPI:1053822627
Name:K.T. ADULT DAY CENTER LLC
Entity Type:Organization
Organization Name:K.T. ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYANASADAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKHILI TABATABAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-881-8991
Mailing Address - Street 1:3766 N 86TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2830
Mailing Address - Country:US
Mailing Address - Phone:414-881-8991
Mailing Address - Fax:
Practice Address - Street 1:3766 N 86TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2830
Practice Address - Country:US
Practice Address - Phone:414-881-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care