MEDICARE: KAY VENTURES 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1720762016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY VENTURES LLC

Provider Business Mailing Address
First Line	:	1100 BUSINESS PKWY S STE 1
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S LAKESIDE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-8426
Country	:	US
Telephone Number	:	443-204-5800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF COMPLIANCE
Name	:	DESIREE MOUNTAIN
Credential	:
Telephone Number	:	443-204-5800

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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