Provider Demographics
NPI:1376018895
Name:KETTER, ABRAHAM E
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:E
Last Name:KETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 TWISTED OAKS RD APT 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7317
Mailing Address - Country:US
Mailing Address - Phone:704-433-1700
Mailing Address - Fax:704-509-9208
Practice Address - Street 1:4708 TWISTED OAKS RD APT 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7317
Practice Address - Country:US
Practice Address - Phone:704-433-1700
Practice Address - Fax:704-509-9208
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness