Provider Demographics
NPI:1417123985
Name:SENIOR CARE OF KOKOMO, LLC DBA COMFORT KEEPERS #566
Entity Type:Organization
Organization Name:SENIOR CARE OF KOKOMO, LLC DBA COMFORT KEEPERS #566
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-868-9230
Mailing Address - Street 1:1511 W SYCAMORE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4230
Mailing Address - Country:US
Mailing Address - Phone:765-868-9230
Mailing Address - Fax:
Practice Address - Street 1:1511 W SYCAMORE ST STE A
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4230
Practice Address - Country:US
Practice Address - Phone:765-868-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200802120Medicaid