=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013397884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEMEKO FAMILY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2015
-----------------------------------------------------
Last Update Date | 06/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9705 HORACE HARDING EXPY SUITE 8A
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368-4157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-296-2604
-----------------------------------------------------
Fax | 929-296-2604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 97-05 HORACE HARDING EXPRESSWAY SUITE 6A
-----------------------------------------------------
City | QUEENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-296-2604
-----------------------------------------------------
Fax | 929-296-2604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | BENJAMIN ONODU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 929-296-2604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------