Provider Demographics
NPI:1376804427
Name:KOSTIC GROUP LLC
Entity Type:Organization
Organization Name:KOSTIC GROUP LLC
Other - Org Name:KOSTIC HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOYIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ADELAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-672-6175
Mailing Address - Street 1:2985 GORDY PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3078
Mailing Address - Country:US
Mailing Address - Phone:770-672-6175
Mailing Address - Fax:770-578-9126
Practice Address - Street 1:2985 GORDY PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3078
Practice Address - Country:US
Practice Address - Phone:770-672-6175
Practice Address - Fax:770-578-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033R1034251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health