MEDICARE: K F E EMPIRE SUPPORT SERVICES

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932736824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K F E EMPIRE SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	2580 N RANCHO STE 104 A
Second Line	:	2580 N RANCHO
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 N RANCHO
Second Line	:	STE 104 A
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-8903
Country	:	US
Telephone Number	:	480-795-0209
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ADRIAN KING II
Credential	:	QMHA
Telephone Number	:	480-795-0209

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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