Provider Demographics
NPI:1568900876
Name:KETTER DBA SNIDER ADULT FOSTER CARE, KATHRYN D
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:D
Last Name:KETTER DBA SNIDER ADULT FOSTER CARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16337 ESTHER RD
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5574
Mailing Address - Country:US
Mailing Address - Phone:903-707-4259
Mailing Address - Fax:
Practice Address - Street 1:16337 ESTHER RD
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771
Practice Address - Country:US
Practice Address - Phone:903-707-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004936021501Medicaid