Organization
KETTLY HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETTLY DERIVAL RN (CEO)
(954) 546-0667
Entity
Organization
Contact information
Practice address
2191 NW 74TH AVE, SUNRISE, FL 33313-3855
(954) 546-0667
Mailing address
2191 NW 74TH AVE, SUNRISE, FL 33313-3855
(954) 546-0667
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
09/04/2025
Last updated
09/04/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us