KMG HOLDINGS, INC (NPI# 1467579490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467579490 |
| Entity Type | Organization |
| Organization Name | KMG HOLDINGS, INC |
| Other Organization Name | THE LIGHTHOUSE |
| Practice Address |
956 N O'neil Street Clayton NC 27520-6457 |
| Mailing Address |
Po Box 24914 Raleigh NC 27611-4914 |
| Practice Telephone | 9195508038 |
| Mailing Telephone | 9195508038 |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2015-04-16 |
| Authorized Official Name | MR. KORY KALE (CFO) |
| Authorized Official Telephone | 9197954438 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-051114 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6603214 | 05 |
| Other Name | Type Code |
|---|---|
| The Lighthouse | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518084227 | Kmg Holdings, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2016 Fort Dr, Clayton, NC 27520-9491 | 2007-03-26 |
| Street Address |
956 N O'NEIL STREET |
| City | CLAYTON |
| State | NC |
| Zip Code | 27520-6457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336750959 | Ebony Nichole Sanders | Driver | 312 Kilgo, Clayton, NC 27520 | 2020-08-17 |
| 1831701382 | Deawna Jackson | Social Worker | 205 Gracie Lane, Clayton, NC 27520 | 2020-08-17 |
| 1952947798 | Mac Partners LLC | Home Health | 10027 Hwy 70 Business, Suite B, Clayton, NC 27520 | 2019-11-26 |
| 1386291102 | Benjamin R Anderson | Physician Assistant | 2138 Nc 42, Clayton, NC 27520 | 2019-08-26 |
| 1396217923 | Lindsey R. Williams Dds, Pa | Dentist | 45 Shotwell Rd., Clayton, NC 27520 | 2018-12-20 |
| 1063987303 | Christopher James Lane | Physician Assistant | 2076 Nc 42 W, Suite 230, Clayton, NC 27520 | 2018-10-12 |
| 1245733971 | Cordelia O Emebo | Pharmacist | 11360 Old Us Hwy 70 West, Clayton, NC 27520 | 2018-03-08 |
| 1487166906 | Kendall Bonot Rodgers | Physician Assistant | 11491 Us 70 Bus Hwy W, Clayton, NC 27520 | 2017-10-25 |
| 1033620828 | Laura Nguyen | Physician Assistant | 2076 Nc-42, Suite 230, Clayton, NC 27520 | 2017-10-19 |
| 1467974394 | Liliana Galvan | Social Worker | 510 W Main St., Suit 100, Clayton, NC 27520 | 2017-07-12 |
| Find all providers in zip 27520 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568611440 | Gifted Visions LLC | Residential Treatment Facility, Emotionally Disturbed Children | 148 Carrie Dr, Clayton, NC 27527-5731 | 2008-09-16 |
| 1871706382 | Second Nature Blue Ridge | Residential Treatment Facility, Emotionally Disturbed Children | 236 File Street, Clayton, GA 30525-3023 | 2007-05-08 |
| 1518084227 | Kmg Holdings, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2016 Fort Dr, Clayton, NC 27520-9491 | 2007-03-26 |
| 1255791919 | House of Hope of Nc | Residential Treatment Facility, Emotionally Disturbed Children | 408 Covered Bridge Rd, Clayton, NC 27520-6559 | 2016-02-24 |
| 1629113170 | Rose of Sharon Adolescent Treatment Home II | Residential Treatment Facility, Emotionally Disturbed Children | 2885 Bennington Dr, Clayton, NC 27520-5971 | 2007-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617255 | Creative Helping Hands LLC | Residential Treatment Facility, Emotionally Disturbed Children | 478 Green Lake Rd, Rockingham, NC 28379-7850 | 2020-10-19 |
| 1083237986 | Revive Housing LLC | Residential Treatment Facility, Emotionally Disturbed Children | 210 Sunset Dr Apt 615, Salisbury, NC 28147-7147 | 2020-05-26 |
| 1457998627 | Re Health Group | Residential Treatment Facility, Emotionally Disturbed Children | 1102 Groves St, Kings Mountain, NC 28086-2232 | 2019-12-05 |
| 1821631532 | Marquita Latrice Walls | Residential Treatment Facility, Emotionally Disturbed Children | 1565 Longbranch Rd, Grover, NC 28073-9599 | 2019-10-25 |
| 1699233866 | A Brighter Path LLC | Residential Treatment Facility, Emotionally Disturbed Children | 120 Jetter Rd, Grover, NC 28073-9687 | 2019-03-06 |
| 1821562224 | Carter Clinic, Pa | Residential Treatment Facility, Emotionally Disturbed Children | 703 W 3rd Ave Bldg A, Red Springs, NC 28377-1524 | 2019-01-18 |
| 1659842607 | Gervonia Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1714 Aster Ln, Gastonia, NC 28054-8303 | 2018-12-16 |
| 1679058440 | Miracle Houses Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7827 Kerrybrook Cir, Charlotte, NC 28214-2513 | 2018-09-27 |
| 1174048078 | A Safe Place Community Housing, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2049 Highland St, Charlotte, NC 28208-4909 | 2017-08-11 |
| 1104346881 | Inspiration for Us | Residential Treatment Facility, Emotionally Disturbed Children | 1205 W Mountain St, Kernersville, NC 27284-2173 | 2017-06-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.