Provider Demographics
NPI:1467952804
Name:A KINGS PLACE SPECIALTY GROUP HOME
Entity Type:Organization
Organization Name:A KINGS PLACE SPECIALTY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:615-894-8719
Mailing Address - Street 1:3012 DELTA QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1132
Mailing Address - Country:US
Mailing Address - Phone:615-894-8719
Mailing Address - Fax:
Practice Address - Street 1:145 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-5954
Practice Address - Country:US
Practice Address - Phone:615-894-8719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management