Provider Demographics
NPI:1841705118
Name:KINGSLAND CARE SERVICES INCORPORATED
Entity type:Organization
Organization Name:KINGSLAND CARE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ABOUDEM
Authorized Official - Last Name:ATEMKENG
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MSW, LGSW
Authorized Official - Phone:651-500-9053
Mailing Address - Street 1:2301 RICE STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-262-2540
Mailing Address - Fax:651-493-8895
Practice Address - Street 1:2301 RICE STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-262-2540
Practice Address - Fax:651-493-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA707458100Medicaid