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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