Provider Demographics
NPI:1649826553
Name:K.S.I GROUP LLC
Entity type:Organization
Organization Name:K.S.I GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-703-9390
Mailing Address - Street 1:15328 W PEAK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6905
Mailing Address - Country:US
Mailing Address - Phone:602-703-9390
Mailing Address - Fax:888-475-1999
Practice Address - Street 1:15328 W PEAK VIEW RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-6905
Practice Address - Country:US
Practice Address - Phone:602-703-9390
Practice Address - Fax:888-475-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility