Provider Demographics
NPI:1750011847
Name:KLS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:KLS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSANTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARATURO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:516-474-1561
Mailing Address - Street 1:9201 N 25TH AVE STE 143
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2722
Mailing Address - Country:US
Mailing Address - Phone:516-474-1561
Mailing Address - Fax:
Practice Address - Street 1:9201 N 25TH AVE STE 143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2722
Practice Address - Country:US
Practice Address - Phone:516-474-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty