Provider Demographics
NPI:1851123889
Name:KOFFLER PROPERTIES LLC
Entity type:Organization
Organization Name:KOFFLER PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:760-889-2571
Mailing Address - Street 1:3104 O ST # 143
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6519
Mailing Address - Country:US
Mailing Address - Phone:760-889-2571
Mailing Address - Fax:
Practice Address - Street 1:3722 43RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1319
Practice Address - Country:US
Practice Address - Phone:760-889-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility