Healthcare Provider Details

I. General information

NPI: 1346487147
Provider Name (Legal Business Name): KGS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MCCUTCHEON DR
LAFAYETTE IN
47909-3430
US

IV. Provider business mailing address

128 MCCUTCHEON DR
LAFAYETTE IN
47909-3430
US

V. Phone/Fax

Practice location:
  • Phone: 765-477-7000
  • Fax: 765-477-7004
Mailing address:
  • Phone: 765-477-7000
  • Fax: 765-477-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number08-011714-1
License Number StateIN

VIII. Authorized Official

Name: MRS. GALE J SCHWIETERMAN
Title or Position: OWNER
Credential:
Phone: 765-477-7000