Provider Demographics
NPI:1487913679
Name:KING OF KINGS HOME HEALTH CARE SERVICE, LLC
Entity type:Organization
Organization Name:KING OF KINGS HOME HEALTH CARE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:651-329-4047
Mailing Address - Street 1:200 3RD ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4903
Mailing Address - Country:US
Mailing Address - Phone:651-329-4047
Mailing Address - Fax:651-351-0503
Practice Address - Street 1:200 3RD ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4903
Practice Address - Country:US
Practice Address - Phone:651-329-4047
Practice Address - Fax:651-351-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN355568251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health