Organization
KATHLEENS RESIDENTIAL INC
Active
Other names
Kathleens Care Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS C VICIAN (ADMINISTRATOR)
(712) 852-2267
Entity
Organization
Contact information
Practice address
1505 E 5TH ST, ENIMETSBURG, IA 50536-1403
(712) 852-2267
(712) 852-2362
Mailing address
1505 E 5TH ST, PO BOX 279, ENIMETSBURG, IA 50536-1403
(712) 852-2267
(712) 852-2362
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
740018
IA
Other
Enumeration date
12/08/2006
Last updated
08/22/2020
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