Provider Demographics
NPI:1841339017
Name:KINGS GROUP HOME FOR CHILDREN, INC.
Entity type:Organization
Organization Name:KINGS GROUP HOME FOR CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-303-5002
Mailing Address - Street 1:109 EVENING STAR DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4029
Mailing Address - Country:US
Mailing Address - Phone:919-303-5002
Mailing Address - Fax:919-363-5655
Practice Address - Street 1:109 EVENING STAR DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4029
Practice Address - Country:US
Practice Address - Phone:919-303-5002
Practice Address - Fax:919-363-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092550320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities