Provider Demographics
NPI:1346627460
Name:KENNETH B WALKER RESIDENTIAL HOME INC
Entity Type:Organization
Organization Name:KENNETH B WALKER RESIDENTIAL HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MHP
Authorized Official - Phone:706-681-1991
Mailing Address - Street 1:3575 MACON RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-8200
Mailing Address - Country:US
Mailing Address - Phone:706-940-0478
Mailing Address - Fax:706-940-0479
Practice Address - Street 1:3575 MACON RD
Practice Address - Street 2:SUITE 25
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8200
Practice Address - Country:US
Practice Address - Phone:706-940-0478
Practice Address - Fax:706-940-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness