Healthcare Provider Details

I. General information

NPI: 1609249267
Provider Name (Legal Business Name): KC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 S BROOKHURST RD
FULLERTON CA
92833-3709
US

IV. Provider business mailing address

451 W LINCOLN AVE STE 100
ANAHEIM CA
92805-2912
US

V. Phone/Fax

Practice location:
  • Phone: 714-449-1339
  • Fax: 714-449-1289
Mailing address:
  • Phone: 714-527-6561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number112371
License Number StateCA

VIII. Authorized Official

Name: MRS. ANNA KEIDERLING
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 714-527-6361