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General NPI Number Information
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NPI Number | 1881054658
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Entity Type | Organization
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Legal Business Name | KD SUPPORT SERVICES
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 2073 HARRIS HENRIETTA RD
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City | MOORESBORO
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State | NC
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Zip | 28114-8233
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Country | US
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Telephone | 828-657-4757
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Fax | 828-245-4099
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Provider Business Mailing Address
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Address Line | 158 US HIGHWAY 221A
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City | FOREST CITY
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State | NC
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Zip | 28043-5600
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Country | US
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Telephone | 828-245-4011
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Fax | 828-245-4099
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | KENNETH DELLINGER
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Credential | BS;QP
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Telephone | 828-245-4011
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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 | MHL-081-069
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License Number State | NC
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