Provider Demographics
NPI:1801257530
Name:KMB ENDEAVORS, INC
Entity type:Organization
Organization Name:KMB ENDEAVORS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEELEE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BURTCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD BCBA
Authorized Official - Phone:303-493-1483
Mailing Address - Street 1:14415 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1238
Mailing Address - Country:US
Mailing Address - Phone:720-524-7648
Mailing Address - Fax:720-542-9098
Practice Address - Street 1:14415 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1238
Practice Address - Country:US
Practice Address - Phone:720-524-7648
Practice Address - Fax:720-542-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
CO11417336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19152736Medicaid