Provider Demographics
NPI:1245815497
Name:KSA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:KSA HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADAPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-704-5559
Mailing Address - Street 1:6391 SMITHY SQ APT C
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-1370
Mailing Address - Country:US
Mailing Address - Phone:202-704-5559
Mailing Address - Fax:
Practice Address - Street 1:6391 SMITHY SQ APT C
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-1370
Practice Address - Country:US
Practice Address - Phone:202-704-5559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care