Provider Demographics
NPI:1780077867
Name:KANATHAN LLC
Entity type:Organization
Organization Name:KANATHAN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CADACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-515-5575
Mailing Address - Street 1:4450 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1887
Mailing Address - Country:US
Mailing Address - Phone:209-405-1374
Mailing Address - Fax:209-808-5239
Practice Address - Street 1:4450 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1887
Practice Address - Country:US
Practice Address - Phone:209-405-1374
Practice Address - Fax:209-808-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1500119404251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health