Provider Demographics
NPI:1558071308
Name:KINGSWAY INTERNATIONAL LLC
Entity Type:Organization
Organization Name:KINGSWAY INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRINCEWILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWAOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-202-8447
Mailing Address - Street 1:9732 NORTHSTAR CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-5183
Mailing Address - Country:US
Mailing Address - Phone:209-932-9481
Mailing Address - Fax:
Practice Address - Street 1:9732 NORTHSTAR CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-5183
Practice Address - Country:US
Practice Address - Phone:209-932-9481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility