Provider Demographics
NPI:1194906495
Name:K & B HEALTH CARE INC
Entity type:Organization
Organization Name:K & B HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOLADE
Authorized Official - Middle Name:
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-862-0169
Mailing Address - Street 1:1428 109TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4211
Mailing Address - Country:US
Mailing Address - Phone:763-862-0169
Mailing Address - Fax:763-862-0365
Practice Address - Street 1:1428 109TH AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4211
Practice Address - Country:US
Practice Address - Phone:763-862-0169
Practice Address - Fax:763-862-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335537261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service