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General NPI Number Information
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NPI Number | 1568226165
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Entity Type | Organization
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Legal Business Name | KLW HOME FOR U, LLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 117 OPOSSUM TROT CT
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-9072
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Country | US
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Telephone | 252-200-4143
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Fax |
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Provider Business Mailing Address
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Address Line | 3695 SUNSET AVE UNIT 7072
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-0105
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Country | US
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Telephone | 252-606-4484
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Fax | 252-606-4033
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BENITA GRANT
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Credential |
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Telephone | 252-606-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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