Provider Demographics
NPI:1033838073
Name:KINGSMARK HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:KINGSMARK HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:AYOTUNDE
Authorized Official - Last Name:OLADIMEJI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-926-0805
Mailing Address - Street 1:6422 TERESA LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7401
Mailing Address - Country:US
Mailing Address - Phone:214-926-0805
Mailing Address - Fax:
Practice Address - Street 1:6422 TERESA LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7401
Practice Address - Country:US
Practice Address - Phone:214-926-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty