Provider Demographics
NPI:1710247762
Name:KING OF KINGS MEN'S RECOVERY HOME
Entity Type:Organization
Organization Name:KING OF KINGS MEN'S RECOVERY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:CAS I
Authorized Official - Phone:559-442-0400
Mailing Address - Street 1:2267 S GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-4326
Mailing Address - Country:US
Mailing Address - Phone:559-266-6449
Mailing Address - Fax:559-266-1532
Practice Address - Street 1:2267 S GENEVA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-4326
Practice Address - Country:US
Practice Address - Phone:559-266-6449
Practice Address - Fax:559-266-1532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING OF KINGS COMMUNITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100024AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility