Provider Demographics
NPI:1427187434
Name:KAT'S ELDERCARE LLC
Entity Type:Organization
Organization Name:KAT'S ELDERCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-0496
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610
Mailing Address - Country:US
Mailing Address - Phone:907-262-0496
Mailing Address - Fax:907-260-3340
Practice Address - Street 1:53030 AURORA AVE.
Practice Address - Street 2:
Practice Address - City:KASILOF
Practice Address - State:AK
Practice Address - Zip Code:99610
Practice Address - Country:US
Practice Address - Phone:907-262-0496
Practice Address - Fax:907-260-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000238347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC36261Medicaid