MEDICARE: KINGS TOWERS 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1831868348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS TOWERS LLC

Provider Business Mailing Address
First Line	:	2005 CALUMET AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1608
Country	:	US
Telephone Number	:	419-467-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 CALUMET AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1608
Country	:	US
Telephone Number	:	419-467-6970
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAYNA KING
Credential	:
Telephone Number	:	419-467-6970

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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Directions to “KINGS TOWERS LLC ” Practice Location

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