Provider Demographics
NPI:1083390744
Name:KING HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:KING HEALTH SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SULE
Authorized Official - Middle Name:ISHOLA
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:443-804-7652
Mailing Address - Street 1:5757 DOW AVE APT 139
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5101
Mailing Address - Country:US
Mailing Address - Phone:703-888-2113
Mailing Address - Fax:
Practice Address - Street 1:5757 DOW AVE APT 139
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5101
Practice Address - Country:US
Practice Address - Phone:703-888-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities