Provider Demographics
NPI:1750856555
Name:KAIROS CENTER MARYLAND, INC
Entity Type:Organization
Organization Name:KAIROS CENTER MARYLAND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-332-4568
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:NORTH BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20714-0025
Mailing Address - Country:US
Mailing Address - Phone:301-332-4568
Mailing Address - Fax:
Practice Address - Street 1:4041 7TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714-5029
Practice Address - Country:US
Practice Address - Phone:301-332-4568
Practice Address - Fax:202-315-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health