MEDICARE: KP ENTERPRISES, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1366250102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KP ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	8435 PROGRESS DR STE FF
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-4981
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-682-2041
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	GLORIA CORBIN
Credential	:
Telephone Number	:	301-732-6300

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	01/07/2025

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Directions to “KP ENTERPRISES, INC ” Practice Location

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