Provider Demographics
NPI:1194109579
Name:KAN ENTERPRISE INC
Entity type:Organization
Organization Name:KAN ENTERPRISE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THOMASENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-478-7426
Mailing Address - Street 1:600 N GRACE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4843
Mailing Address - Country:US
Mailing Address - Phone:252-407-8055
Mailing Address - Fax:
Practice Address - Street 1:600 N GRACE ST
Practice Address - Street 2:SUITE E
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4843
Practice Address - Country:US
Practice Address - Phone:252-407-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health