Provider Demographics
NPI:1932573540
Name:NEXT TO KIN SUPPORTIVE SERVICES LLC
Entity Type:Organization
Organization Name:NEXT TO KIN SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LUCSHUNDA
Authorized Official - Middle Name:SAPRINA
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-510-7847
Mailing Address - Street 1:1049 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3751
Mailing Address - Country:US
Mailing Address - Phone:330-510-7847
Mailing Address - Fax:
Practice Address - Street 1:1049 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3751
Practice Address - Country:US
Practice Address - Phone:330-510-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7714003253J00000X, 253Z00000X, 343900000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No253J00000XAgenciesFoster Care Agency
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7714003OtherDEPARTMENT OF DEVELOPMENTALLY DISABLED
OH0097171Medicaid