Provider Demographics
NPI:1801447099
Name:KINGSWAY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:KINGSWAY HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KINGDOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-221-5248
Mailing Address - Street 1:12050 NORWAY ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2242
Mailing Address - Country:US
Mailing Address - Phone:763-221-5248
Mailing Address - Fax:
Practice Address - Street 1:9248 QUEENS GDNS
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1641
Practice Address - Country:US
Practice Address - Phone:763-221-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health