| K's House | |
|
5556 Shoshone Pass Ellenwood GA 30294-6677 | |
| (770) 474-5800 | |
| (770) 474-6444 |
| Full Name | K's House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5556 Shoshone Pass, Ellenwood, Georgia |
| Authorized Official Name and Position | Kaye S Crumbley (OWNER/DIRECTOR) |
| Authorized Official Contact | 7704745800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| K's House 5556 Shoshone Pass Ellenwood GA 30294 Ph: (770) 474-5800 | K's House 5556 Shoshone Pass Ellenwood GA 30294-6677 Ph: (770) 474-5800 |
| NPI Number | 1972803310 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972803310 | NPI | - | NPPES |
| 667111020A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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