Provider Demographics
NPI:1518110840
Name:KINGSWAY HOME HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:KINGSWAY HOME HEALTH SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-761-8342
Mailing Address - Street 1:6630 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5019
Mailing Address - Country:US
Mailing Address - Phone:773-761-8342
Mailing Address - Fax:773-761-3388
Practice Address - Street 1:7115 N RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3503
Practice Address - Country:US
Practice Address - Phone:773-761-8342
Practice Address - Fax:773-761-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011014251E00000X
IL4000413251J00000X
IL3000999253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid