Provider Demographics
NPI:1144837980
Name:KING HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:KING HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-725-5464
Mailing Address - Street 1:3502 W ROGERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4749
Mailing Address - Country:US
Mailing Address - Phone:410-578-4340
Mailing Address - Fax:
Practice Address - Street 1:14201 LAUREL PARK DR STE 206
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-725-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200109439OtherMARYLAND MEDICAID