Provider Demographics
NPI:1700900784
Name:KAMARA EXTREME CARE,LLC
Entity Type:Organization
Organization Name:KAMARA EXTREME CARE,LLC
Other - Org Name:PCHSERVICES,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-572-0371
Mailing Address - Street 1:PO BOX 393125
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0053
Mailing Address - Country:US
Mailing Address - Phone:770-572-0371
Mailing Address - Fax:678-831-0509
Practice Address - Street 1:1521 REDDINGTON LN
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2455
Practice Address - Country:US
Practice Address - Phone:770-572-0371
Practice Address - Fax:678-831-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities