Provider Demographics
NPI:1902470610
Name:KINGZKID HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:KINGZKID HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-653-6237
Mailing Address - Street 1:1801 W TOUHY AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 W TOUHY AVE UNIT C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2335
Practice Address - Country:US
Practice Address - Phone:773-653-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4000663Medicaid