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General NPI Number Information
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NPI Number | 1083390744
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Entity Type | Organization
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Legal Business Name | KING HEALTH SYSTEMS, LLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 5757 DOW AVE APT 139
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City | ALEXANDRIA
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State | VA
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Zip | 22304-5101
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Country | US
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Telephone | 703-888-2113
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Fax |
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Provider Business Mailing Address
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Address Line | 5757 DOW AVE APT 139
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City | ALEXANDRIA
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State | VA
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Zip | 22304-5101
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Country | US
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Telephone | 703-888-2113
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SULE ISHOLA SALAKO
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Credential | OWNER
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Telephone | 443-804-7652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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