Provider Demographics
NPI:1659429389
Name:KC1
Entity type:Organization
Organization Name:KC1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARINGOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-284-0076
Mailing Address - Street 1:226 W NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5254
Mailing Address - Country:US
Mailing Address - Phone:724-284-0076
Mailing Address - Fax:724-284-9729
Practice Address - Street 1:317 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6921
Practice Address - Country:US
Practice Address - Phone:724-284-0076
Practice Address - Fax:724-284-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA415990320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness