Healthcare Provider Details

I. General information

NPI: 1295270312
Provider Name (Legal Business Name): KSS ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CLEVELAND RD
BOYCE LA
71409-9284
US

IV. Provider business mailing address

107 CLEVELAND RD
BOYCE LA
71409-9284
US

V. Phone/Fax

Practice location:
  • Phone: 318-793-8453
  • Fax: 318-793-5378
Mailing address:
  • Phone: 318-793-8453
  • Fax: 318-793-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. GLENDA S WASHINGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 318-793-8453