Provider Demographics
NPI:1114166329
Name:K & K HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:K & K HEALTHCARE SYSTEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OMOLAYO
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:AKINBOTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-289-4254
Mailing Address - Street 1:201 ELEANOR CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9123
Mailing Address - Country:US
Mailing Address - Phone:678-289-4254
Mailing Address - Fax:678-289-4254
Practice Address - Street 1:201 ELEANOR CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9123
Practice Address - Country:US
Practice Address - Phone:678-289-4254
Practice Address - Fax:678-289-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075R0014251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA755123874AMedicaid