Healthcare Provider Details

I. General information

NPI: 1932788619
Provider Name (Legal Business Name): K&I HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11637 TERRACE DR STE 201
WALDORF MD
20602-3708
US

IV. Provider business mailing address

11637 TERRACE DR STE 201
WALDORF MD
20602-3708
US

V. Phone/Fax

Practice location:
  • Phone: 240-419-3803
  • Fax: 240-419-2931
Mailing address:
  • Phone: 240-419-3803
  • Fax: 240-419-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IKECHUKWU OBIORA
Title or Position: CEO
Credential:
Phone: 517-214-3258