Provider Demographics
NPI:1780130070
Name:KINGSWAY HOME CARE SERVICE, INC.
Entity type:Organization
Organization Name:KINGSWAY HOME CARE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESEO-KUTEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:518-382-8187
Mailing Address - Street 1:321 KINGS RD
Mailing Address - Street 2:C#5
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-3697
Mailing Address - Country:US
Mailing Address - Phone:518-382-8187
Mailing Address - Fax:
Practice Address - Street 1:321 KINGS RD
Practice Address - Street 2:C#5
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-3645
Practice Address - Country:US
Practice Address - Phone:518-382-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9952L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health