Provider Demographics
NPI:1013672195
Name:KC CENTER FOR HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:KC CENTER FOR HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:216-232-5302
Mailing Address - Street 1:3793 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5705
Mailing Address - Country:US
Mailing Address - Phone:216-232-5302
Mailing Address - Fax:216-393-3690
Practice Address - Street 1:3793 GREEN RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5705
Practice Address - Country:US
Practice Address - Phone:216-232-5302
Practice Address - Fax:216-393-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty