Provider Demographics
NPI:1861082901
Name:KIH ADVANCED KARE, LLC
Entity type:Organization
Organization Name:KIH ADVANCED KARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-861-4218
Mailing Address - Street 1:10281 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4603
Mailing Address - Country:US
Mailing Address - Phone:228-604-2155
Mailing Address - Fax:
Practice Address - Street 1:10281 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4603
Practice Address - Country:US
Practice Address - Phone:228-604-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service