Provider Demographics
NPI:1073126447
Name:KAC FOR SENIORS, INC.
Entity Type:Organization
Organization Name:KAC FOR SENIORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-712-5700
Mailing Address - Street 1:4872 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5662
Mailing Address - Country:US
Mailing Address - Phone:213-712-5700
Mailing Address - Fax:
Practice Address - Street 1:4872 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5662
Practice Address - Country:US
Practice Address - Phone:213-712-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health