Provider Demographics
NPI:1013218817
Name:KINGS AND QUEENS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:KINGS AND QUEENS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-987-5785
Mailing Address - Street 1:3331 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1923
Mailing Address - Country:US
Mailing Address - Phone:614-987-5785
Mailing Address - Fax:614-987-5973
Practice Address - Street 1:3331 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1923
Practice Address - Country:US
Practice Address - Phone:614-987-5785
Practice Address - Fax:614-987-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2387186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056549Medicaid