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General NPI Number Information
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NPI Number | 1518853845
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Entity Type | Organization
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Legal Business Name | KMB RESIDENTIAL CARE, INC.
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 18425 BURBANK BLVD STE 506
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City | TARZANA
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State | CA
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Zip | 91356-6913
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Country | US
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Telephone | 818-501-5375
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Fax |
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Provider Business Mailing Address
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Address Line | 8574 COLE CREST DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-1914
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Country | US
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Telephone | 818-501-5375
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CARL L KING
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Credential | PHD
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Telephone | 818-359-5732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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