Organization
LORIQUEN HOLDINGS DBA KINKISTRY
Active
Organization
LORIQUEN HOLDINGS DBA KINKISTRY
Active
Parent organization
LORIQUEN HOLDINGS
Organization subpart
Yes
Provider details
NPI number
Legal business name
LORIQUEN HOLDINGS
Authorized official
ANGELA FITE (OWNER)
(404) 416-3818
Entity
Organization
Contact information
Practice address
5623 VININGS PLACE TRL, MABLETON, GA 30126-5681
(404) 416-3818
Mailing address
5623 VININGS PLACE TRL, MABLETON, GA 30126-5681
(404) 416-3818
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
CAQH
GA
Enumeration date
10/15/2021
Last updated
10/15/2021
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