Provider Demographics
NPI:1780900068
Name:KF ONTARIO HEALTHCARE LLC
Entity type:Organization
Organization Name:KF ONTARIO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-308-7191
Mailing Address - Street 1:1661 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5826
Mailing Address - Country:US
Mailing Address - Phone:909-984-6713
Mailing Address - Fax:
Practice Address - Street 1:1661 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5826
Practice Address - Country:US
Practice Address - Phone:909-984-6713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780900068Medicaid
CA055707Medicare Oscar/Certification