Provider Demographics
NPI:1003255902
Name:KEMETIC SERVICES LLC
Entity Type:Organization
Organization Name:KEMETIC SERVICES LLC
Other - Org Name:KEMETIC BEHAVIORAL HEALTH SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-423-8870
Mailing Address - Street 1:608 S CLAYPOOL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2506
Mailing Address - Country:US
Mailing Address - Phone:302-745-5351
Mailing Address - Fax:757-271-9229
Practice Address - Street 1:5635 RABY RD STE D
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2465
Practice Address - Country:US
Practice Address - Phone:757-337-3968
Practice Address - Fax:757-306-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities