Healthcare Provider Details

I. General information

NPI: 1699107516
Provider Name (Legal Business Name): K&M INTERVENTION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 LAKEWATER VIEW LN
STONE MOUNTAIN GA
30087-6507
US

IV. Provider business mailing address

682 LAKEWATER VIEW LN
STONE MOUNTAIN GA
30087-6507
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-6268
  • Fax:
Mailing address:
  • Phone: 646-872-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN ALLEYNE-PIERRE
Title or Position: OWNER
Credential:
Phone: 646-872-6268