Healthcare Provider Details

I. General information

NPI: 1396890711
Provider Name (Legal Business Name): REM-KIKS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 MOUNTAIN DR
DECATUR GA
30032-1203
US

IV. Provider business mailing address

3448 MOUNTAIN DR
DECATUR GA
30032-1203
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-1995
  • Fax: 404-294-1944
Mailing address:
  • Phone: 404-294-1995
  • Fax: 404-294-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number044-R-0132
License Number StateGA

VIII. Authorized Official

Name: GREGORY OJO
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 404-294-1995