Provider Demographics
NPI:1447766670
Name:KAES CUBE OF LIFE LLC
Entity Type:Organization
Organization Name:KAES CUBE OF LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-204-2715
Mailing Address - Street 1:3909 S MARYLAND PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7520
Mailing Address - Country:US
Mailing Address - Phone:702-701-8882
Mailing Address - Fax:
Practice Address - Street 1:3909 S MARYLAND PKWY STE 305
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7520
Practice Address - Country:US
Practice Address - Phone:702-701-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities