Provider Demographics
NPI:1558790618
Name:KECHI SUPPORTED LIVING, INC
Entity Type:Organization
Organization Name:KECHI SUPPORTED LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:METAGHEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-476-8872
Mailing Address - Street 1:1148 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3510
Mailing Address - Country:US
Mailing Address - Phone:510-472-6259
Mailing Address - Fax:925-679-7067
Practice Address - Street 1:51079 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:925-476-8872
Practice Address - Fax:925-679-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health