Provider Demographics
NPI:1255792016
Name:KD SUPPORT SERVICES
Entity type:Organization
Organization Name:KD SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:BS;QP
Authorized Official - Phone:828-245-4011
Mailing Address - Street 1:158 US HIGHWAY 221A
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-5600
Mailing Address - Country:US
Mailing Address - Phone:828-245-4011
Mailing Address - Fax:828-245-4099
Practice Address - Street 1:126 PINE ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-4587
Practice Address - Country:US
Practice Address - Phone:828-245-2540
Practice Address - Fax:828-245-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-081-113323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418462Medicaid