Kenneth B Walker Residential Home Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

KENNETH B WALKER RESIDENTIAL HOME INC

Practice address

3575 Macon Rd
Suite 25
Columbus, GA 31907-8200

Phone

(706) 940-0478

Fax

(706) 940-0479

NPI assigned

Apr 27, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Crumbley, MS, MHP

Title

Chief Executive Officer

Phone

(706) 681-1991

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430179200000",
    "number": "1346627460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3575 MACON RD",
            "address_2": "SUITE 25",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319078200",
            "telephone_number": "706-940-0478",
            "fax_number": "706-940-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 MACON RD",
            "address_2": "SUITE 25",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319078200",
            "telephone_number": "706-940-0478",
            "fax_number": "706-940-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH B WALKER RESIDENTIAL HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2015-04-28",
        "status": "A",
        "authorized_official_last_name": "CRUMBLEY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "706-681-1991",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, MHP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria L Kennedy
• Debra Kennedy, NP
• Kelly Amanda Kennedy, PHARMD.
• Shannon Nicole Kennedy
• Travis J Kennedy, PHARM.D.
• Wendy Hawkins Kennon, AA
• Samantha Kent, SLP
• Yolanda Kent, FNP
• Cameron Caldwell Kersey, M.D.
• Latia Kersey, RN

• Mental Illness Community Based Residential Treatment Facility in Columbus, GA
• Providers in Columbus, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.