Provider Demographics
NPI:1699372656
Name:KATHLEEN CORLETO
Entity Type:Organization
Organization Name:KATHLEEN CORLETO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-519-3220
Mailing Address - Street 1:3180 AMANDA GAYLE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2602
Mailing Address - Country:US
Mailing Address - Phone:907-519-3220
Mailing Address - Fax:
Practice Address - Street 1:3180 AMANDA GAYLE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2602
Practice Address - Country:US
Practice Address - Phone:907-519-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility