Provider Demographics
NPI:1811454325
Name:KAIKAL LEGACIES, LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:KAIKAL LEGACIES, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEZOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-622-7240
Mailing Address - Street 1:315 E MAIN ST OFC 2
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2433
Mailing Address - Country:US
Mailing Address - Phone:608-850-7335
Mailing Address - Fax:608-850-7336
Practice Address - Street 1:315 E MAIN ST OFC 2
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2433
Practice Address - Country:US
Practice Address - Phone:608-850-7335
Practice Address - Fax:608-850-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care