Provider Demographics
NPI:1528302577
Name:KRA LLC
Entity type:Organization
Organization Name:KRA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ACHILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-465-2421
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:HAVEN
Mailing Address - State:KS
Mailing Address - Zip Code:67543-0280
Mailing Address - Country:US
Mailing Address - Phone:620-465-2421
Mailing Address - Fax:620-465-2643
Practice Address - Street 1:410 N RENO ST
Practice Address - Street 2:
Practice Address - City:HAVEN
Practice Address - State:KS
Practice Address - Zip Code:67543-9276
Practice Address - Country:US
Practice Address - Phone:620-465-2421
Practice Address - Fax:620-465-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X, 310400000X
KSB078029311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home