Healthcare Provider Details

I. General information

NPI: 1992612485
Provider Name (Legal Business Name): KMC INDEPENDENT LIVING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W MILLBROOK RD STE 210
RALEIGH NC
27609-4490
US

IV. Provider business mailing address

207 W MILLBROOK RD STE 210
RALEIGH NC
27609-4490
US

V. Phone/Fax

Practice location:
  • Phone: 919-576-9584
  • Fax:
Mailing address:
  • Phone: 919-576-9584
  • Fax:

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: MS. CARLENE CUMMINGS
Title or Position: OWNER/MANAGER
Credential:
Phone: 919-576-9584