Kathleens Residential Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

740018 Issued in IA

Legal business name

KATHLEENS RESIDENTIAL INC

Doing business as

Kathleens Care Inc

Practice address

1505 E 5TH St
Enimetsburg, IA 50536-1403

Phone

(712) 852-2267

Fax

(712) 852-2362

NPI assigned

Dec 8, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dennis C Vician

Title

Administrator

Phone

(712) 852-2267

Specialties & licenses 1

Addresses

Other names 1

• Kathleens Care Inc Doing business as

Tax ID family

Kathleens Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Kathleens Residential Care Inc

  • Custodial Care Facility
  • Emmetsburg, IA
  • NPI 1356415152
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285793984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 E 5TH ST",
            "address_2": "PO BOX 279",
            "city": "ENIMETSBURG",
            "state": "IA",
            "postal_code": "505361403",
            "telephone_number": "712-852-2267",
            "fax_number": "712-852-2362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E 5TH ST",
            "city": "ENIMETSBURG",
            "state": "IA",
            "postal_code": "505361403",
            "telephone_number": "712-852-2267",
            "fax_number": "712-852-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEENS RESIDENTIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VICIAN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "712-852-2267",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IA",
            "license": "740018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kathleens Care Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.