Provider Demographics
NPI:1639542293
Name:KELLOGG SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KELLOGG SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-653-3680
Mailing Address - Street 1:3300 ELDORADO PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3300 ELDORADO PKWY STE 500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5745
Practice Address - Country:US
Practice Address - Phone:972-569-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDE GRACE DAHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
3OtherVA
TX2Medicaid