Provider Demographics
NPI:1184279861
Name:KATHRYN D. KETTER
Entity type:Organization
Organization Name:KATHRYN D. KETTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-707-4259
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:75771-5574
Practice Address - Country:US
Practice Address - Phone:903-707-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home