Healthcare Provider Details

I. General information

NPI: 1669123766
Provider Name (Legal Business Name): KMB ENDEAVORS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 GRANITE WAY
CASTLE ROCK CO
80108-7529
US

IV. Provider business mailing address

5865 GRANITE WAY
CASTLE ROCK CO
80108-7529
US

V. Phone/Fax

Practice location:
  • Phone: 303-493-1483
  • Fax:
Mailing address:
  • Phone: 303-493-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KEELEE K. BURTCH
Title or Position: DIRECTOR
Credential: PHD
Phone: 303-493-1483