MEDICARE: KC CENTER FOR HEALTH AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013672195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC CENTER FOR HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	3793 GREEN RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5705
Country	:	US
Telephone Number	:	216-232-5302
Fax Number	:	216-393-3690

Provider Business Practice Location Address
First Line	:	3793 GREEN RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5705
Country	:	US
Telephone Number	:	216-232-5302
Fax Number	:	216-393-3690

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEY KING
Credential	:	APRN-C
Telephone Number	:	216-232-5302

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	05/18/2026

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