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General NPI Number Information
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NPI Number | 1013586734
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Entity Type | Organization
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Legal Business Name | K & W SERVICES LLC
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 5802 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1618
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Country | US
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Telephone | 612-470-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 5802 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TREATMENT DIRECTOR
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Name | SAMANTHA WALKER
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Credential | MS, ADCT, NCPRSS
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Telephone | 612-470-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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