Provider Demographics
NPI:1740432723
Name:K.I.S.S. HOUSE, WOMEN IN RECOVERY
Entity Type:Organization
Organization Name:K.I.S.S. HOUSE, WOMEN IN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-899-0294
Mailing Address - Street 1:9370 ECKERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5911
Mailing Address - Country:US
Mailing Address - Phone:916-791-4361
Mailing Address - Fax:
Practice Address - Street 1:9370 ECKERMAN RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5911
Practice Address - Country:US
Practice Address - Phone:916-791-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility