Provider Demographics
NPI:1528391976
Name:KC HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:KC HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KOLAWOLE
Authorized Official - Middle Name:LOOKMAN
Authorized Official - Last Name:AMUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-442-1716
Mailing Address - Street 1:295 MCNIGHT ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119
Mailing Address - Country:US
Mailing Address - Phone:651-442-1716
Mailing Address - Fax:
Practice Address - Street 1:295 MCNIGHT ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119
Practice Address - Country:US
Practice Address - Phone:651-442-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN344292251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health