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General NPI Number Information
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NPI Number | 1902569023
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Entity Type | Organization
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Legal Business Name | LORIQUEN HOLDINGS DBA KINKISTRY
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 5623 VININGS PLACE TRL
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City | MABLETON
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State | GA
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Zip | 30126-5681
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Country | US
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Telephone | 404-416-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 5623 VININGS PLACE TRL
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City | MABLETON
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State | GA
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Zip | 30126-5681
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Country | US
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Telephone | 404-416-3818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA FITE
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Credential |
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Telephone | 404-416-3818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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