Provider Demographics
NPI:1174198774
Name:KMB ENDEAVORS, INC
Entity Type:Organization
Organization Name:KMB ENDEAVORS, INC
Other - Org Name:KMB ELEVATION HCBS PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEELEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-493-1483
Mailing Address - Street 1:13721 E RICE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1062
Mailing Address - Country:US
Mailing Address - Phone:303-493-1483
Mailing Address - Fax:
Practice Address - Street 1:13721 E RICE PL STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1062
Practice Address - Country:US
Practice Address - Phone:303-493-1483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900162081Medicaid