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General NPI Number Information
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NPI Number | 1972803310
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Entity Type | Organization
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Legal Business Name | K'S HOUSE
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 5556 SHOSHONE PASS
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City | ELLENWOOD
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State | GA
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Zip | 30294-6677
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Country | US
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Telephone | 770-474-5800
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Fax | 770-474-6444
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Provider Business Mailing Address
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Address Line | 5556 SHOSHONE PASS
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City | ELLENWOOD
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State | GA
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Zip | 30294
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Country | US
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Telephone | 770-474-5800
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Fax | 770-474-6444
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | KAYE S CRUMBLEY
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Credential |
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Telephone | 770-474-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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