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General NPI Number Information
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NPI Number | 1346487147
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Entity Type | Organization
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Legal Business Name | KGS SERVICES LLC
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 128 MCCUTCHEON DR
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City | LAFAYETTE
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State | IN
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Zip | 47909-3430
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Country | US
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Telephone | 765-477-7000
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Fax | 765-477-7004
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Provider Business Mailing Address
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Address Line | 128 MCCUTCHEON DR
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City | LAFAYETTE
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State | IN
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Zip | 47909-3430
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Country | US
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Telephone | 765-477-7000
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Fax | 765-477-7004
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GALE J SCHWIETERMAN
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Credential |
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Telephone | 765-477-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 08-011714-1
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License Number State | IN
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