MEDICARE: KINGS BEHAVIORAL HEALTH SERVICES, INC.

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023553641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2158 CUMBERLAND PKWY SE
Second Line	:	7202
City	:	ATLANTA
State	:	GA
Zip	:	30339-4539
Country	:	US
Telephone Number	:	919-594-2629
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 CUMBERLAND PKWY SE
Second Line	:	7202
City	:	ATLANTA
State	:	GA
Zip	:	30339-4539
Country	:	US
Telephone Number	:	919-594-2629
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. RACHEL KING
Credential	:
Telephone Number	:	919-594-2629

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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