Provider Demographics
NPI:1427232800
Name:KINSHIP INDIVIDUALIZED SUPPORTIVE SERVICES INC
Entity Type:Organization
Organization Name:KINSHIP INDIVIDUALIZED SUPPORTIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:CHIRSTEL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-799-8085
Mailing Address - Street 1:21407 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2154
Mailing Address - Country:US
Mailing Address - Phone:216-799-8085
Mailing Address - Fax:
Practice Address - Street 1:21407 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2154
Practice Address - Country:US
Practice Address - Phone:216-799-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage