Provider Demographics
NPI:1659101103
Name:KAVOD HEALTHCARE SYSTEM LLC
Entity type:Organization
Organization Name:KAVOD HEALTHCARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TITILOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIMBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-872-0828
Mailing Address - Street 1:438 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1236
Mailing Address - Country:US
Mailing Address - Phone:862-872-0828
Mailing Address - Fax:
Practice Address - Street 1:438 S 17TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1236
Practice Address - Country:US
Practice Address - Phone:862-872-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management