NPIMap

Organization Active NPI

KD Support Services

Doing business as Kellys Care

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Mooresboro, NC
National Provider Identifier
1881054658
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-081-069 Issued in NC
Legal business name
KD SUPPORT SERVICES
Doing business as
Kellys Care
Practice address
2073 Harris Henrietta Rd
Mooresboro, NC 28114-8233
Phone
(828) 657-4757
Fax
(828) 245-4099
NPI assigned
Mar 7, 2016
Last updated
Mar 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Authorized official

Name
Kenneth Dellinger, BS;QP
Title
Director of Operations
Phone
(828) 245-4011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-081-069 NC Primary

Addresses

Primary practice location

2073 Harris Henrietta Rd
Mooresboro, NC 28114-8233

Mailing address

158 US Highway 221a
Forest City, NC 28043-5600
Phone (828) 245-4011

Other identifiers 1

IdentifierTypeStateIssuer
3418462MedicaidNC

Other names 1

  • Kellys Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
KD Support Services9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

2073 Harris Henrietta Rd
Mooresboro, NC 28114
Phone (828) 657-4757

NPI Registry JSON

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457308800000",
    "number": "1881054658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 US HIGHWAY 221A",
            "city": "FOREST CITY",
            "state": "NC",
            "postal_code": "280435600",
            "telephone_number": "828-245-4011",
            "fax_number": "828-245-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2073 HARRIS HENRIETTA RD",
            "city": "MOORESBORO",
            "state": "NC",
            "postal_code": "281148233",
            "telephone_number": "828-657-4757",
            "fax_number": "828-245-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KD SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2016-03-07",
        "status": "A",
        "authorized_official_last_name": "DELLINGER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "828-245-4011",
        "authorized_official_credential": "BS;QP"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-081-069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418462",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kellys Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; 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.