NPIMap

Organization Active NPI

KMB Residential Care, Inc.

Doing business as Cantlay House

  • Intellectual Disabilities Intermediate Care Facility
  • Van Nuys, CA
National Provider Identifier
1083800890
Registry record updated Sep 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
960001364 Issued in CA
Legal business name
KMB RESIDENTIAL CARE, INC.
Doing business as
Cantlay House
Practice address
14160 Cantlay St
Van Nuys, CA 91405-2431
Phone
(818) 501-5375
Fax
(818) 360-1940
NPI assigned
Sep 15, 2007
Last updated
Sep 15, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carl Leonard KingNPI 1962628933
Title
President
Phone
(818) 501-5375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 960001364 CA Primary

Addresses

Primary practice location

14160 Cantlay St
Van Nuys, CA 91405-2431

Mailing address

12544 Fraser Ave
Granada Hills, CA 91344-1321
Phone (818) 501-5375

Other identifiers 1

IdentifierTypeStateIssuer
LTC61012FMedicaidCA

Other names 1

  • Cantlay House Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083800890. Details of each certification follow.

  • CCN 55G457 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G457

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CANTLAY HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 22, 2003
Last certification
Nov 26, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
14160 Cantlay Street
Van Nuys, CA 91405

National Provider Directory

National Provider Directory
Tax ID family
KMB Residential Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189814400000",
    "number": "1083800890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12544 FRASER AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913441321",
            "telephone_number": "818-501-5375",
            "fax_number": "818-360-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14160 CANTLAY ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914052431",
            "telephone_number": "818-501-5375",
            "fax_number": "818-360-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMB RESIDENTIAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-15",
        "last_updated": "2007-09-15",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "LEONARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-501-5375",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "960001364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC61012F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cantlay House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.