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General NPI Number Information
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NPI Number | 1003579467
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Entity Type | Organization
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Legal Business Name | K&W CARE HOMES
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 4496 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3539
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Country | US
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Telephone | 678-403-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 2698 SUMMIT HILLS DR
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City | TUCKER
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State | GA
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Zip | 30084-2947
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Country | US
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Telephone | 770-369-0695
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KIRK TUCKER
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Credential |
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Telephone | 770-369-0695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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