Provider Demographics
NPI:1306218268
Name:KCSINC
Entity Type:Organization
Organization Name:KCSINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIDERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-449-1125
Mailing Address - Street 1:451 W LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2912
Mailing Address - Country:US
Mailing Address - Phone:714-527-6561
Mailing Address - Fax:
Practice Address - Street 1:7212 ORANGETHORPE AVE STE 9A
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4668
Practice Address - Country:US
Practice Address - Phone:714-449-1125
Practice Address - Fax:714-562-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health