Provider Demographics
NPI:1770046559
Name:KHESSED RECEPTIVE HOME CARE
Entity Type:Organization
Organization Name:KHESSED RECEPTIVE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWADAMILOLA
Authorized Official - Middle Name:SEUN
Authorized Official - Last Name:PHILIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-322-2550
Mailing Address - Street 1:20 COMMERCE WAY STE 10
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:951 DIGHTON WOODS CIR
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02715-1161
Practice Address - Country:US
Practice Address - Phone:774-322-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care