Provider Demographics
NPI:1306205398
Name:K D SUPPORT SERVICES / KELLY'S CARE
Entity Type:Organization
Organization Name:K D SUPPORT SERVICES / KELLY'S CARE
Other - Org Name:KELLYS CARE 6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:BS;QP
Authorized Official - Phone:828-245-4011
Mailing Address - Street 1:158 US HIGHWAY 221A
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5600
Mailing Address - Country:US
Mailing Address - Phone:828-245-4011
Mailing Address - Fax:828-245-4099
Practice Address - Street 1:158 US HIGHWAY 221A
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-5600
Practice Address - Country:US
Practice Address - Phone:828-245-8223
Practice Address - Fax:828-245-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418462Medicaid