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General NPI Number Information
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NPI Number | 1720215585
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Entity Type | Organization
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Legal Business Name | KLR INTERESTS, INC.
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 5716 SOUTHERN BLVD SUITE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2409
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Country | US
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Telephone | 757-518-2800
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Fax | 757-518-2801
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Provider Business Mailing Address
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Address Line | PO BOX 2552
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City | VIRGINIA BEACH
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State | VA
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Zip | 23450-2552
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Country | US
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Telephone | 757-518-2800
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Fax | 757-518-2801
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KEVIN L LARGE
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Credential |
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Telephone | 757-518-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-0986
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License Number State | VA
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