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General NPI Number Information
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NPI Number | 1255048542
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Entity Type | Organization
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Legal Business Name | KING AND LORD CARE 'KLC' LLC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 501 WESTBROOK STREET 209B
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-321-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 501 WESTBROOK STREET 209B
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-321-1605
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER CEO
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Name | MR. TRESOR ELIJAH BEYA
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Credential |
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Telephone | 207-321-1605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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