Provider Demographics
NPI:1720792658
Name:KINGSWAY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:KINGSWAY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBORU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-405-5067
Mailing Address - Street 1:13231 W CREOSOTE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7843
Mailing Address - Country:US
Mailing Address - Phone:602-405-5067
Mailing Address - Fax:
Practice Address - Street 1:13231 W CREOSOTE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7843
Practice Address - Country:US
Practice Address - Phone:602-405-5067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty