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General NPI Number Information
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NPI Number | 1962788273
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Entity Type | Organization
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Legal Business Name | R & K CONSULTING AND PERSONAL CARE HOMES, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 6400 BEETHOVEN CIR
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City | RIVERDALE
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State | GA
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Zip | 30296-2335
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Country | US
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Telephone | 770-909-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 5595 HEARN RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-3238
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Country | US
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Telephone | 770-322-5317
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REGENIA KISER
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Credential |
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Telephone | 404-310-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | CLA001073
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License Number State | GA
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