Provider Demographics
NPI:1568226165
Name:KLW HOME FOR U, LLC
Entity Type:Organization
Organization Name:KLW HOME FOR U, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-606-4484
Mailing Address - Street 1:3695 SUNSET AVE UNIT 7072
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0105
Mailing Address - Country:US
Mailing Address - Phone:252-606-4484
Mailing Address - Fax:252-606-4033
Practice Address - Street 1:117 OPOSSUM TROT CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9072
Practice Address - Country:US
Practice Address - Phone:252-200-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness