Provider Demographics
NPI:1306674734
Name:KINDNESS MY SON'S LEGACY
Entity type:Organization
Organization Name:KINDNESS MY SON'S LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEWUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:443-850-2500
Mailing Address - Street 1:10326 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1918
Mailing Address - Country:US
Mailing Address - Phone:443-850-2500
Mailing Address - Fax:
Practice Address - Street 1:10326 VINCENT RD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-1918
Practice Address - Country:US
Practice Address - Phone:443-850-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service