Provider Demographics
NPI:1306472766
Name:IKOOT INC
Entity type:Organization
Organization Name:IKOOT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EO
Authorized Official - Prefix:
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-737-5995
Mailing Address - Street 1:9212 MIRANDA LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6919
Mailing Address - Country:US
Mailing Address - Phone:919-737-5995
Mailing Address - Fax:
Practice Address - Street 1:9212 MIRANDA LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6919
Practice Address - Country:US
Practice Address - Phone:919-737-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty