Provider Demographics
NPI:1629655956
Name:KOMFOT PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:KOMFOT PROVIDER SERVICES LLC
Other - Org Name:KOMFOT PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TITILOPE
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:ADEYOSOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-773-7572
Mailing Address - Street 1:107 FOREST MILL TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4812
Mailing Address - Country:US
Mailing Address - Phone:817-773-7572
Mailing Address - Fax:
Practice Address - Street 1:107 FOREST MILL TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4812
Practice Address - Country:US
Practice Address - Phone:817-773-7572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty