Healthcare Provider Details

I. General information

NPI: 1295696946
Provider Name (Legal Business Name): KINDRED HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 HAVEN ST
KANNAPOLIS NC
28083-8808
US

IV. Provider business mailing address

9611 BROOKDALE DR STE 100
CHARLOTTE NC
28215-8776
US

V. Phone/Fax

Practice location:
  • Phone: 704-963-9001
  • Fax:
Mailing address:
  • Phone: 1
  • Fax: 1

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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KENYETTA DUGAN
Title or Position: PRESIDENT
Credential:
Phone: 1