Provider Demographics
NPI:1861622995
Name:K & M PRIVATE CARE
Entity type:Organization
Organization Name:K & M PRIVATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GOINS-HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR,PSSA
Authorized Official - Phone:423-285-5246
Mailing Address - Street 1:301 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-5380
Mailing Address - Country:US
Mailing Address - Phone:423-285-5246
Mailing Address - Fax:423-285-5337
Practice Address - Street 1:301 KEITH DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5380
Practice Address - Country:US
Practice Address - Phone:423-285-5246
Practice Address - Fax:423-285-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI438-087-9138253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445213Medicaid