Provider Demographics
NPI:1417554494
Name:KINGSLEY HEALTHCARE AND SOCIAL SERVICES LLC
Entity Type:Organization
Organization Name:KINGSLEY HEALTHCARE AND SOCIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:IYERE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:623-266-6767
Mailing Address - Street 1:20283 N LAKE PLEASANT RD STE 112-113
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9701
Mailing Address - Country:US
Mailing Address - Phone:623-266-6767
Mailing Address - Fax:623-225-7555
Practice Address - Street 1:20449 N LAKE PLEASANT RD STE 104-106
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2654
Practice Address - Country:US
Practice Address - Phone:623-266-6767
Practice Address - Fax:623-225-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services