Provider Demographics
NPI:1588832216
Name:KING DAVID HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:KING DAVID HOME HEALTH CARE SERVICES
Other - Org Name:RELIANT HOME HEALTH CARE SERVIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BBC DEGREE
Authorized Official - Phone:651-459-5023
Mailing Address - Street 1:7758 JANERO COURT SO.
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016
Mailing Address - Country:US
Mailing Address - Phone:651-459-5023
Mailing Address - Fax:651-769-0788
Practice Address - Street 1:7758 JANERO CT
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-2217
Practice Address - Country:US
Practice Address - Phone:651-459-5023
Practice Address - Fax:651-769-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health