1144837980 NPI number — KING HEALTH SYSTEMS, INC.

Table of content: LAUREN NICHOLE-EVANS JESKE NURSE PRACTITIONER (NPI 1346874997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144837980 NPI number — KING HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KING HEALTH SYSTEMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144837980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3502 W ROGERS AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-4749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-578-4340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14201 LAUREL PARK DR STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-725-5464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SALAKO
Authorized Official First Name:
SULE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-725-5464

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200109439 . This is a "MARYLAND MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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