Provider Demographics
NPI:1134366388
Name:KINDER LOVE HOMS
Entity type:Organization
Organization Name:KINDER LOVE HOMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMETKA
Authorized Official - Middle Name:BLOUNT
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-454-7761
Mailing Address - Street 1:908 PENNCROSS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2185
Mailing Address - Country:US
Mailing Address - Phone:919-454-7761
Mailing Address - Fax:919-326-1699
Practice Address - Street 1:1202 ELLIS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6027
Practice Address - Country:US
Practice Address - Phone:919-454-7761
Practice Address - Fax:919-326-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC032458322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children