Provider Demographics
NPI:1396890711
Name:REM-KIKS GROUP LLC
Entity type:Organization
Organization Name:REM-KIKS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-294-1995
Mailing Address - Street 1:3448 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1203
Mailing Address - Country:US
Mailing Address - Phone:404-294-1995
Mailing Address - Fax:404-294-1944
Practice Address - Street 1:3448 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1203
Practice Address - Country:US
Practice Address - Phone:404-294-1995
Practice Address - Fax:404-294-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QA0600X
GA044-R-0132251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922017BMedicaid
GA000922017CMedicaid
GA000922017DMedicaid
GA000922017EMedicaid
GA000922017AMedicaid
GA519005916AMedicaid
GA519005916AMedicaid