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General NPI Number Information
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NPI Number | 1801001904
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Entity Type | Organization
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Legal Business Name | KINGSLEY HOUSE INC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 CONSTANCE STREET
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City | NEW ORLEANS
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State | LA
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Zip | 70130-4641
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Country | US
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Telephone | 504-523-6221
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Fax | 504-523-4450
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Provider Business Mailing Address
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Address Line | 1600 CONSTANCE STREET
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City | NEW ORLEANS
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State | LA
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Zip | 70130-4641
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Country | US
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Telephone | 504-523-6221
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Fax | 504-523-4450
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEITH LIEDERMAN
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Credential | PHD
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Telephone | 504-523-6221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 0002525
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License Number State | LA
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