Healthcare Provider Details

I. General information

NPI: 1306598917
Provider Name (Legal Business Name): KC COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 MINNESOTA AVE SE STE A
WASHINGTON DC
20020-5300
US

IV. Provider business mailing address

2412 MINNESOTA AVE SE STE A
WASHINGTON DC
20020-5300
US

V. Phone/Fax

Practice location:
  • Phone: 202-957-7456
  • Fax: 202-747-7754
Mailing address:
  • Phone: 202-957-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. INNOCENT CHIA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 240-481-0557