Healthcare Provider Details

I. General information

NPI: 1821129362
Provider Name (Legal Business Name): K D SUPPORT SERVICES / KELLY'S CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 US HIGHWAY 221A
FOREST CITY NC
28043
US

IV. Provider business mailing address

467 W MAIN ST
FOREST CITY NC
28043-2920
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-4011
  • Fax: 828-245-4099
Mailing address:
  • Phone: 828-245-4011
  • Fax: 828-245-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KEN DELLINGER
Title or Position: DIRECTOR OF OPERATIONS
Credential: BS;QP
Phone: 828-245-4011