Provider Demographics
NPI:1184876443
Name:KC COMPANIES OF CROSSLAKE, INC.
Entity type:Organization
Organization Name:KC COMPANIES OF CROSSLAKE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-217-2640
Mailing Address - Street 1:13631 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CROSSLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56442-2767
Mailing Address - Country:US
Mailing Address - Phone:218-692-6650
Mailing Address - Fax:218-629-6652
Practice Address - Street 1:13631 E SHORE RD
Practice Address - Street 2:
Practice Address - City:CROSSLAKE
Practice Address - State:MN
Practice Address - Zip Code:56442
Practice Address - Country:US
Practice Address - Phone:218-692-6650
Practice Address - Fax:218-692-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility