Organization
KLW HOME FOR U, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BENITA GRANT (ADMINISTRATOR)
(252) 606-4484
Entity
Organization
Contact information
Practice address
117 OPOSSUM TROT CT, ROCKY MOUNT, NC 27804-9072
(252) 200-4143
Mailing address
3695 SUNSET AVE UNIT 7072, ROCKY MOUNT, NC 27804-0105
(252) 606-4484
(252) 606-4033
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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