Provider Demographics
NPI:1083369979
Name:KAHO HEALTHCARE TRAINING FACILITY, LLC
Entity Type:Organization
Organization Name:KAHO HEALTHCARE TRAINING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY-KAHO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-451-5018
Mailing Address - Street 1:PO BOX 2252
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-2252
Mailing Address - Country:US
Mailing Address - Phone:601-451-5018
Mailing Address - Fax:601-451-5018
Practice Address - Street 1:90 AVENDALE ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-3906
Practice Address - Country:US
Practice Address - Phone:601-451-5018
Practice Address - Fax:601-451-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare