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Organization
KMB RESIDENTIAL CARE, INC.
Active
Organization
KMB RESIDENTIAL CARE, INC.
Active
Other names
Cantlay House
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL LEONARD KING (PRESIDENT)
(818) 501-5375
Entity
Organization
Contact information
Practice address
14160 CANTLAY ST, VAN NUYS, CA 91405-2431
(818) 501-5375
(818) 360-1940
Mailing address
12544 FRASER AVE, GRANADA HILLS, CA 91344-1321
(818) 501-5375
(818) 360-1940
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960001364
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC61012F
—
CA
Enumeration date
09/15/2007
Last updated
09/15/2007
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