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General NPI Number Information
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NPI Number | 1447057856
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Entity Type | Organization
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Legal Business Name | KING'S DOMINION HOME HEALTHCARE SERVICES CORPORATION
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2104 TREMONT AVE
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City | YORKVILLE
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State | IL
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Zip | 60560-8049
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Country | US
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Telephone | 312-200-8251
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 TREMONT AVE
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City | YORKVILLE
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State | IL
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Zip | 60560-8049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SAMSON OLADOSU
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Credential |
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Telephone | 312-200-8251
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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 |
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License Number State |
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