Provider Demographics
NPI:1285294306
Name:KIARAD ENTERPRISES SERVICES LLC
Entity type:Organization
Organization Name:KIARAD ENTERPRISES SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-730-0368
Mailing Address - Street 1:3554 CARNEY ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-5032
Mailing Address - Country:US
Mailing Address - Phone:901-730-0368
Mailing Address - Fax:901-531-8398
Practice Address - Street 1:3994 EDENBURG DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-4112
Practice Address - Country:US
Practice Address - Phone:901-730-0368
Practice Address - Fax:901-531-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities