Provider Demographics
NPI:1043012180
Name:KC / CK LLC
Entity type:Organization
Organization Name:KC / CK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:BSECE / EMT
Authorized Official - Phone:925-451-1803
Mailing Address - Street 1:3724 NORTHPARK CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1458
Mailing Address - Country:US
Mailing Address - Phone:925-451-1803
Mailing Address - Fax:925-566-8331
Practice Address - Street 1:3724 NORTHPARK CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-1458
Practice Address - Country:US
Practice Address - Phone:925-451-1803
Practice Address - Fax:925-566-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility