Basic Information
| Provider Information | |||||||||
| NPI: | 1609249267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KC SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 W LINCOLN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145276561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1060 S BROOKHURST RD | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928333709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144491339 | ||||||||
| FaxNumber: | 7144491289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2015 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEIDERLING | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7145276361 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 112371 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.