Healthcare Provider Details

I. General information

NPI: 1669989703
Provider Name (Legal Business Name): KC CENTER FOR HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
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

11811 SHAKER BLVD STE 123
CLEVELAND OH
44120-1927
US

V. Phone/Fax

Practice location:
  • Phone: 216-242-2990
  • Fax: 216-455-5436
Mailing address:
  • Phone: 162-232-5302
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY KING
Title or Position: CEO/FOUNDER
Credential: MSN, AGNP-C
Phone: 440-339-0218