| Organization Name: | KENNETH B WALKER RESIDENTIAL HOME INC |
| NPI Number: | 1346627460 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY CRUMBLEY (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 3575 Macon Rd Suite 25 Columbus |
| State: | GA US |
| Postal Code: | 319078200 |
| Phone Number: | 7069400478 |
| Fax Number: | 7069400479 |
| NPI Enumeration Date: | 04/27/2015 |
| NPI Last Update Date: | 04/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |