Provider Demographics
NPI:1063781995
Name:KINGSVILLE CARE
Entity type:Organization
Organization Name:KINGSVILLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COORDINATION CFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULRASHEED
Authorized Official - Middle Name:ADEREMI
Authorized Official - Last Name:SALIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-757-6219
Mailing Address - Street 1:1916 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5877
Mailing Address - Country:US
Mailing Address - Phone:972-757-6219
Mailing Address - Fax:
Practice Address - Street 1:1916 JACKSON DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5877
Practice Address - Country:US
Practice Address - Phone:972-757-6219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health