Provider Demographics
NPI:1871652891
Name:K & L CORF LLC
Entity type:Organization
Organization Name:K & L CORF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-327-7075
Mailing Address - Street 1:PO BOX 2565
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-2565
Mailing Address - Country:US
Mailing Address - Phone:269-373-8878
Mailing Address - Fax:269-373-4720
Practice Address - Street 1:2340 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4465
Practice Address - Country:US
Practice Address - Phone:269-327-7075
Practice Address - Fax:269-327-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30353OtherBLUE CROSS BLUE SHEILD
6430007OtherUNITED HEALTH CARE
MI234531Medicare ID - Type UnspecifiedMEDICARE