Healthcare Provider Details

I. General information

NPI: 1750011847
Provider Name (Legal Business Name): KLS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 N 25TH AVE STE 143
PHOENIX AZ
85021-2722
US

IV. Provider business mailing address

9201 N 25TH AVE STE 143
PHOENIX AZ
85021-2722
US

V. Phone/Fax

Practice location:
  • Phone: 516-474-1561
  • Fax:
Mailing address:
  • Phone: 516-474-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KRYSANTHE CARATURO
Title or Position: SITE ADMINISTRATOR
Credential: MBA
Phone: 516-474-1561