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NPI Code Detail

MEDICARE: KUSH INC.

MEDICARE: KUSH INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1619725272
Entity Type Code : Organization
Provider Name (Legal Business Name) : KUSH INC.
Provider Business Mailing Address
First Line : 250 PARK AVENUE WEST NW UNIT 903
Second Line :
City : ATLANTA
State : GA
Zip : 30313-1607
Country : US
Telephone Number : 323-270-2165
Fax Number :
Provider Business Practice Location Address
First Line : 4595 PADDOCK RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-1131
Country : US
Telephone Number : 323-270-2165
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. TIYRONE WARREN
Credential :
Telephone Number : 323-270-2165
Provider Enumeration Date : 05/08/2024
Last Update Date : 05/08/2024

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Directions to “KUSH INC. ” Practice Location

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