Provider Demographics
NPI:1891848503
Name:KLM HEALTHCARE AGENCY INC
Entity Type:Organization
Organization Name:KLM HEALTHCARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-842-1685
Mailing Address - Street 1:4807 N STATE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4826
Mailing Address - Country:US
Mailing Address - Phone:601-362-7690
Mailing Address - Fax:601-362-7691
Practice Address - Street 1:4807 N STATE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4826
Practice Address - Country:US
Practice Address - Phone:601-362-7690
Practice Address - Fax:601-362-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR804231251G00000X, 251S00000X, 251T00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Not Answered385H00000XRespite Care FacilityRespite Care