Healthcare Provider Details

I. General information

NPI: 1225199573
Provider Name (Legal Business Name): KHI SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19530 DOCTORS DR
GERMANTOWN MD
20874-5200
US

IV. Provider business mailing address

19530 DOCTORS DR
GERMANTOWN MD
20874-5200
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-0707
  • Fax: 240-686-0711
Mailing address:
  • Phone: 240-686-0707
  • Fax: 240-686-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number902999
License Number StateMD

VIII. Authorized Official

Name: MR. ROGER D LARSON
Title or Position: EXECUTIVE DIRECTOR
Credential: M.G.A.HCA
Phone: 240-686-0707