Healthcare Provider Details

I. General information

NPI: 1013672195
Provider Name (Legal Business Name): KC CENTER FOR HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 GREEN RD
BEACHWOOD OH
44122-5705
US

IV. Provider business mailing address

3793 GREEN RD
BEACHWOOD OH
44122-5705
US

V. Phone/Fax

Practice location:
  • Phone: 216-232-5302
  • Fax: 216-393-3690
Mailing address:
  • Phone: 216-232-5302
  • Fax: 216-393-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHLEY KING
Title or Position: CEO
Credential: APRN-C
Phone: 216-232-5302