Healthcare Provider Details

I. General information

NPI: 1245815497
Provider Name (Legal Business Name): KSA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6391 SMITHY SQ APT C
GLEN BURNIE MD
21061-1370
US

IV. Provider business mailing address

6391 SMITHY SQ APT C
GLEN BURNIE MD
21061-1370
US

V. Phone/Fax

Practice location:
  • Phone: 202-704-5559
  • Fax:
Mailing address:
  • Phone: 202-704-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHOLA OLADAPO
Title or Position: CEO
Credential:
Phone: 202-704-5559