Provider Demographics
NPI:1376905976
Name:KLS CARE CENTERS
Entity Type:Organization
Organization Name:KLS CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-922-1257
Mailing Address - Street 1:17364 STATE HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17364 STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8732
Practice Address - Country:US
Practice Address - Phone:405-922-1257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility