Provider Demographics
NPI:1720498736
Name:KAISER ADULT FAMILY CARE, LLC
Entity Type:Organization
Organization Name:KAISER ADULT FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-301-3725
Mailing Address - Street 1:311 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5688
Mailing Address - Country:US
Mailing Address - Phone:715-301-3725
Mailing Address - Fax:
Practice Address - Street 1:W782 LEROY ST
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426-9627
Practice Address - Country:US
Practice Address - Phone:715-432-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0014963320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities