MEDICARE: KINSHIP INDIVIDUALIZED SUPPORTIVE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1427232800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINSHIP INDIVIDUALIZED SUPPORTIVE SERVICES INC

Provider Business Mailing Address
First Line	:	21407 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-799-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	21407 RAYMOND ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2154
Country	:	US
Telephone Number	:	216-799-8085
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. RENITA CHIRSTEL ALLEN
Credential	:	LISW
Telephone Number	:	216-799-8085

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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