Provider Demographics
NPI:1063026102
Name:KESJAN ASSISTED LIVING CARE
Entity Type:Organization
Organization Name:KESJAN ASSISTED LIVING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KESJAN
Authorized Official - Middle Name:JRELL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-953-6131
Mailing Address - Street 1:350 DESIARD PLAZA DR STE 117
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4959
Mailing Address - Country:US
Mailing Address - Phone:318-953-6131
Mailing Address - Fax:
Practice Address - Street 1:350 DESIARD PLAZA DR STE 117
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4959
Practice Address - Country:US
Practice Address - Phone:318-953-6131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KESJAN ASSISTED LIVING CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility