Provider Demographics
NPI:1184001588
Name:KEM'S HOUSE INC.
Entity type:Organization
Organization Name:KEM'S HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MAT
Authorized Official - Phone:901-409-1785
Mailing Address - Street 1:3030 COVINGTON PIKE
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5048
Mailing Address - Country:US
Mailing Address - Phone:901-409-1785
Mailing Address - Fax:
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:SUITE 241
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-409-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 261QD1600X, 315P00000X, 320600000X, 320900000X, 347C00000X, 171M00000X, 252Y00000X, 174H00000X, 305S00000X, 251C00000X, 261QA0600X, 235Z00000X
TN251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual DisabilitiesGroup - Single Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013714Medicaid