Provider Demographics
NPI:1306613062
Name:MIKEKINGSTON ASSISTED LIVING INC
Entity type:Organization
Organization Name:MIKEKINGSTON ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:OJOH
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:281-914-8775
Mailing Address - Street 1:1438COURTSIDE PLACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489
Mailing Address - Country:US
Mailing Address - Phone:281-914-8775
Mailing Address - Fax:713-988-6247
Practice Address - Street 1:1438COURTSIDE PLACE DRIVE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489
Practice Address - Country:US
Practice Address - Phone:281-914-8775
Practice Address - Fax:713-988-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility