Provider Demographics
NPI:1366800450
Name:KISMET ALT-A, LLC
Entity type:Organization
Organization Name:KISMET ALT-A, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:705 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:IA
Mailing Address - Zip Code:51002-1525
Mailing Address - Country:US
Mailing Address - Phone:712-200-2620
Mailing Address - Fax:712-200-1174
Practice Address - Street 1:705 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ALTA
Practice Address - State:IA
Practice Address - Zip Code:51002-1525
Practice Address - Country:US
Practice Address - Phone:712-200-2620
Practice Address - Fax:712-200-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0096310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2047972EMedicaid