Healthcare Provider Details

I. General information

NPI: 1033838073
Provider Name (Legal Business Name): KINGSMARK HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6422 TERESA LN
ROWLETT TX
75089-7401
US

IV. Provider business mailing address

6422 TERESA LN
ROWLETT TX
75089-7401
US

V. Phone/Fax

Practice location:
  • Phone: 214-926-0805
  • Fax:
Mailing address:
  • Phone: 214-926-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ABIODUN AYOTUNDE OLADIMEJI
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 214-926-0805