Provider Demographics
NPI: | 1184001588 |
---|---|
Name: | KEM'S HOUSE INC. |
Entity Type: | Organization |
Organization Name: | KEM'S HOUSE INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | KEM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EDWARDS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MED, MAT |
Authorized Official - Phone: | 901-409-1785 |
Mailing Address - Street 1: | 3030 COVINGTON PIKE |
Mailing Address - Street 2: | SUITE 241 |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38128-5048 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-409-1785 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3030 COVINGTON PIKE |
Practice Address - Street 2: | SUITE 241 |
Practice Address - City: | MEMPHIS |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38128-5048 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-409-1785 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-05 |
Last Update Date: | 2017-01-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 171M00000X, 174H00000X, 251C00000X, 252Y00000X, 261QA0600X, 261QD1600X, 305S00000X, 315P00000X, 320600000X, 320900000X, 347C00000X, 235Z00000X | ||
TN | 251V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Single Specialty | |
No | 174H00000X | Other Service Providers | Health Educator | Group - Single Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Single Specialty | |
No | 251V00000X | Agencies | Voluntary or Charitable | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | Group - Single Specialty |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 305S00000X | Managed Care Organizations | Point of Service | Group - Single Specialty | |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | Group - Single Specialty | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Single Specialty | |
No | 347C00000X | Transportation Services | Private Vehicle | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | Q013714 | Medicaid |