Provider Demographics
NPI:1972803310
Name:K'S HOUSE
Entity Type:Organization
Organization Name:K'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRUMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-5800
Mailing Address - Street 1:5556 SHOSHONE PASS
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294
Mailing Address - Country:US
Mailing Address - Phone:770-474-5800
Mailing Address - Fax:770-474-6444
Practice Address - Street 1:5556 SHOSHONE PASS
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-6677
Practice Address - Country:US
Practice Address - Phone:770-474-5800
Practice Address - Fax:770-474-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA667111020AMedicaid