Provider Demographics
NPI:1275930711
Name:KAYGEE40, INCORPORATION
Entity Type:Organization
Organization Name:KAYGEE40, INCORPORATION
Other - Org Name:CAROLKAY HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:TOPE
Authorized Official - Last Name:TAIWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:301-704-5094
Mailing Address - Street 1:6911 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE #303
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1712
Mailing Address - Country:US
Mailing Address - Phone:301-704-5094
Mailing Address - Fax:
Practice Address - Street 1:6911 LAUREL BOWIE RD
Practice Address - Street 2:SUITE #303
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1712
Practice Address - Country:US
Practice Address - Phone:301-704-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1511261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health