Provider Demographics
NPI:1770091431
Name:KINGS ACADEMY
Entity type:Organization
Organization Name:KINGS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-248-2112
Mailing Address - Street 1:1350 W RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1737
Mailing Address - Country:US
Mailing Address - Phone:414-585-9374
Mailing Address - Fax:414-585-0398
Practice Address - Street 1:1350 W RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1737
Practice Address - Country:US
Practice Address - Phone:414-585-9374
Practice Address - Fax:414-585-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0016450251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health