Healthcare Provider Details

I. General information

NPI: 1518084227
Provider Name (Legal Business Name): KMG HOLDINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10307 S OAK ST STE C
MIDDLESEX NC
27557-7824
US

IV. Provider business mailing address

PO BOX 24914
RALEIGH NC
27611-4914
US

V. Phone/Fax

Practice location:
  • Phone: 919-550-8038
  • Fax: 919-882-6311
Mailing address:
  • Phone: 919-553-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-051138
License Number StateNC

VIII. Authorized Official

Name: KORY KALE
Title or Position: CEO
Credential:
Phone: 919-795-4438