Provider Demographics
NPI:1558542407
Name:KMG HOLDINGS, INC.
Entity Type:Organization
Organization Name:KMG HOLDINGS, INC.
Other - Org Name:THE LIGHTHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-795-4438
Mailing Address - Street 1:PO BOX 24914
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-4914
Mailing Address - Country:US
Mailing Address - Phone:919-795-4438
Mailing Address - Fax:919-882-6311
Practice Address - Street 1:1521 RANCH RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6457
Practice Address - Country:US
Practice Address - Phone:919-550-8038
Practice Address - Fax:919-882-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health