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NPI Code Detail

MEDICARE: KLS BEHAVIORAL HEALTH LLC

MEDICARE: KLS BEHAVIORAL HEALTH 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
13245S0500XChildren's Substance Abuse Rehabilitation Facility
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1750011847
Entity Type Code : Organization
Provider Name (Legal Business Name) : KLS BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 9201 N 25TH AVE STE 143
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-2722
Country : US
Telephone Number : 516-474-1561
Fax Number :
Provider Business Practice Location Address
First Line : 9201 N 25TH AVE STE 143
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-2722
Country : US
Telephone Number : 516-474-1561
Fax Number :
Authorized Official
Title or Position : SITE ADMINISTRATOR
Name : KRYSANTHE CARATURO
Credential : MBA
Telephone Number : 516-474-1561
Provider Enumeration Date : 06/13/2022
Last Update Date : 10/31/2022

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Directions to “KLS BEHAVIORAL HEALTH LLC ” Practice Location

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