Provider Demographics
NPI:1881716975
Name:KSSW INC
Entity type:Organization
Organization Name:KSSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-941-0200
Mailing Address - Street 1:4430 N. CIVIC CENTER PLAZA #101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-941-0200
Mailing Address - Fax:480-941-0271
Practice Address - Street 1:4430 N. CIVIC CENTER PLAZA #101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-941-0200
Practice Address - Fax:480-941-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ797045Medicaid
AZ213617Medicaid