1417554494 NPI number — KINGSLEY HEALTHCARE AND SOCIAL SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417554494 NPI number — KINGSLEY HEALTHCARE AND SOCIAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGSLEY HEALTHCARE AND SOCIAL SERVICES LLC
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:
1417554494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20283 N LAKE PLEASANT RD STE 112-113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85382-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-266-6767
Provider Business Mailing Address Fax Number:
623-225-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20449 N LAKE PLEASANT RD STE 104-106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85382-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-266-6767
Provider Business Practice Location Address Fax Number:
623-225-7555
Provider Enumeration Date:
10/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
IYERE
Authorized Official First Name:
KINGSLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
623-266-6767

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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